Method of dispensing and tracking the giving of medical items to patients

ABSTRACT

A method of tracking and dispensing the dispense of medical items for use by patients associated with a health care institution, includes storing in a data store in connection with a computer, data representative of patients and medical items prescribed for the patients. Authorized users such as nurses, are enabled to dispense prescribed items for patients through medical item dispensers. A record is included in the data store that the medical items have been dispensed. In an exemplary system ( 650 ) medical items that have been dispensed are tracked to the point of giving the item to the patients using portable terminals ( 662 ) that are carried to the bedside of the patients. The activity of giving the appropriate medical item to each respective patient is recorded in the portable terminal as medical items are given to a plurality of patients. The data stored in the portable terminal concerning the giving of medical items to patients is communicated through the system and stored in the data store to provide a record that the medical items which were dispensed for a patient, were actually administered.

This application claims the benefit of U.S. Provisional Application No.60/140,894 filed Jun. 24, 1999

This application is a continuation-in-part of copending application Ser.No. 09/086,857 filed on May 29, 1998, which is a continuation-in-part ofSer. No. 08/927,593 filed Sep. 11, 1997 now U.S. Pat. No. 5,912,818,which is a continuation-in-part of Ser. No. 08/361,783 filed Dec. 16,1994 now U.S. Pat. No. 5,790,409.

TECHNICAL FIELD

This invention relates to medical inventory monitoring and dispensingdevices and systems. Particularly this invention relates to apparatusand methods for dispensing and tracking an inventory of medical itemsused to treat patients in a hospital, clinic or other healthcaresetting.

BACKGROUND ART

The treatment of patients in hospitals and clinics usually involves thereceipt by the patient of medical items. These items may includeconsumable items such as medications. Medical treatment may also involveother disposable items such as dressings and bandages or other medicalequipment. Items implanted into the patient or used in conjunction withsurgical procedures may also be used and consumed during the course of apatient's medical treatment. Examples of such items include splints,catheters or guide wires which are normally used during cardiaccatheterization or angioplasty. To serve the needs of its patients, aclinic or hospital must always maintain sufficient stocks of these itemson hand. Further, as medical items are often expensive, the chargesassociated with their use must be accurately billed to the patient.

In the past most systems for tracking inventory and use of medicalequipment items in a hospital or clinic environment have been largelymanual systems. The persons responsible for maintaining an inventory ofparticular items must monitor the use of the items in each storagelocation within the hospital and order additional supplies when it isnoted that the available stocks are running low. Often personnel areonly familiar with the stocks available in a particular storage locationand as a result, additional stocks may be ordered even though amplesupplies are available elsewhere in the same facility.

Certain drugs used in the course of medical treatment are regulatednarcotics. Supplies of such drugs must be kept in secure cabinets. Itemsmay be dispensed from the secure cabinets only by two (2) authorizedusers accessing the material and certifying the manner in which it isused. The use of such narcotics also may require considerable paperworkwhich takes away valuable time that could be used for treating patients.

Some types of medical items must be maintained in refrigerated storage.Often such refrigerated storage must be maintained until almost the timeof use. Keeping track of items that require refrigerated storage andassuring that adequate inventories of such items are always availablepresents additional challenges compared to medical items which do notrequire such special conditions. Due to the diverse types of medicalitems that may require storage in refrigerated conditions it is alsodifficult to selectively restrict access to such items.

The recording of medical items so that the patient may be billed fortheir use in the course of treatment in the past has also been largely amanual operation. The fact of use by the patient must be recorded in thepatient's chart. In some cases items have peel-off labels that include abar code that can be scanned and used for billing purposes. However,this still requires that the nurse or medical technician transfer thecorrect coding to the proper location for later billing.

Complications in billing become even greater when items are removed frominventory to accomplish a planned surgical procedure and then the itemsare not used. A patient may be charged for use of a particular itemwhich is removed from inventory in anticipation of surgery. If duringthe surgery the item is not needed, a corresponding credit must beissued when the item is returned to stock. All of these activities taketime away from persons who could otherwise devote their time to thetreatment of patients. Such tracking and billing practices are alsoprone to inaccuracies which may cause the hospital or clinic to losemoney or which may result in overbilling of the patient.

Thus there exists a need for an apparatus and system for monitoring anddispensing medical items in hospital or clinic environments that canmore accurately monitor inventories, dispense medical items andcorrelate the use of medical items with the patient whose treatment hasincluded their use. There further exists a need for a method and systemfor the restocking of medical items in such a system that provides moreaccurate, convenient and secure movement of medical items from apharmacy or other location where medical items are prepared, to thelocations where the medical items are taken for use by patients.

DISCLOSURE OF INVENTION

It is an object of the present invention to provide a system formonitoring an inventory of medical use items to provide an indication ofwhat items have been used.

It is a further object of the present invention to provide a system formonitoring the use of medical use items so that supplies may bereplenished before depletion.

It is a further object of the present invention to provide a system formonitoring an inventory of medical use items that monitors a pluralityof items in real time.

It is a further object of the present invention to provide a system formonitoring an inventory of medical use items that minimizes theprocessing of paper forms.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that indicates the patientwhose treatment has involved the medical use items.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that can be used to indicatethe technician or physician who has used such medical use items.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that provides for creditingof a patient's account upon return of an unused item to inventory.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that is used to store anddispense restricted items in a secure manner.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that are stored in arefrigerator or other compartment having controlled environmentalconditions.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that can guide a user toselect the items that will be used in a particular medical procedure.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that may be used to trackand dispense a wide variety of various items and to record their use ina clinical or hospital environment.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that enables a user in thecourse of a dispensing sequence to selectively review and dispensemedications by either the generic name or the brand name.

It is a further object of the present invention to provide a system formonitoring and dispensing medications that enables a user to dispensetogether predetermined medical items that are used as a kit in theconduct of a medical procedure.

It is a further object of the present invention to provide a dispensingmechanism that reliably dispenses medicines to a user in response to theuser's selection of items.

It is a further object of the present invention to provide a method formonitoring and dispensing medical use items.

It is a further object of the present invention to provide a method formonitoring an inventory of medical use items that are not tracked to apatient.

It is a further object of the present invention to provide a method andsystem which can track the administration of medical items to patients.

It is a further object of the present invention to provide a method fordispensing medical items and assessing appropriate charges for medicalitems dispensed.

It is a further object of the present invention to provide a method fordispensing medical use items that can be carried out more rapidly andefficiently.

It is a further object of the present invention to provide a method formore efficiently restocking storage locations with medical use items.

It is a further object of the present invention to provide a method forrestocking storage locations with medical use items that providesenhanced security.

It is a further object of the present invention to provide a method forrestocking storage locations with medical use items that reduces errorsin the restocking of storage locations.

It is a further object of the present invention to provide a method forrestocking storage locations with medical use items that employsremovable liners in a storage location which liners can be transportedbetween a stocking location and a storage location from which medicaluse items are taken for patients and which subsequently can be removedfrom storage locations and returned to the stocking location.

It is a further object of the present invention to provide a method forrestocking storage locations with medical use items that includes aliner configuration that can be handled more efficiently duringtransport.

It is a further object of the present invention to provide a method forrestocking storage locations with medical use items that provides atamper indicating container for transporting the medical use items.

It is a further object of the present invention to provide a method formonitoring and dispensing medical use items stored in a refrigerator orother environmentally controlled storage area.

It is a further object of the present invention to provide a system formonitoring and dispensing medical use items that enables monitoring anddispensing of medications when portions of the system are notoperational.

It is a further object of the present invention to provide a method foroperating a system for monitoring and dispensing medical use items thatselectively updates stored information to maximize accuracy.

Further objects of the present invention will be made apparent in thefollowing Best Modes for Carrying Out Invention and the appended claims.

The foregoing objects are accomplished in an exemplary embodiment of theinvention by a system for monitoring and dispensing medical items in anenvironment where patients are provided medical treatment such as aclinical or hospital environment. The system includes a plurality ofitem storage locations. A particular type of medical item may be storedin each location. For example, one type of medical item may include aparticular type of catheter. Another may be a particular type ofmedication packaged in a particular dosage. Each location in the systemincludes at least one unit of the particular type of medical item.

A sensor is positioned adjacent to certain storage locations. The sensoris particularly adapted to sense the addition or subtraction of a unitof the particular type of medical item that is stored in the location.As a result, each time a unit of the particular item is added or removedfrom storage in the location, the sensor senses this and generates asignal.

A counter is connected to each such sensor and records the number ofunits added or removed from each location. The counter holds a count ofthe change in the number of units at the location since the last timethe counter was read.

The counters associated with each location are connected to at least oneprocessor and at least one memory or data store. The data store includesa total of the number of items that are located in storage at thelocation. Periodically, the processor polls each of the counters andreads the change in the number of units stored therein. Thereafter theprocessor is operative to update the total number stored in the memoryto reflect the number of items currently stored at the location.

Embodiments of the invention include a data terminal which includes auser interface and which terminal is connected to the processing systemand the counters. The data store includes records concerning patients,procedures, authorized users of the system and each of the productsstored in each of the locations, including pricing information. The datastore further preferably includes data representative of medical itemsprescribed for patients as well as the medical items that have beentaken by users of the system for patients. The data store furtherpreferably includes data representative of the function the user usuallyperforms and the activities the user has performed. The data storefurther preferably includes data representative of whether eachparticular medical type item is tracked to patients, whether each typeof medical item is billed to patients, and the quantity or level ofmedical items stored in each storage location. The data store may alsoinclude information concerning medical items used in the treatment ofeach patient and when such items were used or given to the patient.

The data store preferably includes data in correlated relationconcerning the brand names and generic names for medications and othermedical items stored in the locations of the system.

The data store further preferably includes information on “kits” whichare groups of medical a items that are used together. Such kits may begroups of items which are used together repeatedly, such as in doing adiagnostic test. Alternatively, a kit may comprise items that are to beused on a one-time basis, such as for a particular patient's operativeprocedure. The data on items in each kit are stored in correlatedrelation with the kit designation in the database.

A system user, such as a technician or nurse, may use the interface ofthe data terminal to identify the particular patient who is to receivethe medical items taken by the user. Upon removal or dispense of theitems from the storage locations, the use of such items is recorded incorrelated relation with the patient record in the data store so thatthe patient's chart may be automatically updated and the item charged.Alternatively the taking of the medications by the user may be stored inthe data store and a later input may be provided to the system toindicate that the medical item has been given to the patient whichinformation is also recorded in the data store. In addition, a userusing the data terminal may review information in the data storeconcerning procedures and physicians to determine what medical items arerequired by a physician to conduct a procedure and may remove such itemsfor delivery to an operating room. This information may include kitswhich relate to particular procedures. The user is enabled to take orcause medical items to be dispensed through inputs to the data terminal.

The user may also use the interface of the data terminal to check stocksof medications which are available as well as medications which havebeen prescribed for a patient. The user is enabled to use the interfaceto check the brand name for medical items designated by generic name,and vice versa. This is done by the user interface interfacing with thedrug information stored in the data store. This enables a user to checkfor the availability of medications by either brand or generic name.This also enables a user to check the appropriate character of an itemprescribed by checking its other name. This also enables a user todetermine the availability and use a brand name or generic nameequivalent to the medical item prescribed, when the brand or generictype prescribed is not available.

In embodiments of the invention, controlled substances such asnarcotics, may be dispensed using the system from a dispenser mechanismor an electronic lock drawer. In some embodiments, the user is requiredto identify himself at the display terminal. This information isprocessed and compared to authorized user records in the data store toverify that the user is an authorized user. In some embodiments theidentifying information on the user may be placed on an encoded objector article such as a card, and the user may be assigned a personalidentification number (PIN) that is memorized by the user. The dataterminal preferably includes a reader for reading the coded object andfor receiving the user's PIN number which has a predeterminedrelationship to the data on the encoded object. The proper input of thePIN with the corresponding user's coded object verifies that a properuser is requesting to gain access to the items. For some strictlycontrolled substances two (2) authorized users may be required to inputtheir coded objects and PIN numbers in order to gain access to thecontrolled items. In alternative embodiments biometric typeidentification devices may be used, such as those that identify a userby fingerprints, hand scans, retina scans, iris scans, voice prints orother body features.

In embodiments of the invention medical items may be stored in aninterior area of a refrigerator. The refrigerator may be of aconventional or unconventional type having a door for accessing theinterior area. The refrigerator may preferably be fitted with a lockmodule which enables selectively enabling access to the interior area inresponse to signals from the display terminal. In exemplary embodimentsthe lock module may be readily attached to exterior surfaces of therefrigerator. A lock module enables the refrigerator to operate in amanner similar to an electronic lock drawer. Varying levels of securityfor refrigerated items may be provided by using several refrigeratorseach of which includes its own lock module. Alternativelysubcompartments within the refrigerator, each with individual lockmodules may be provided.

Other types of environmentally controlled storage and dispensing devicesmay be provided as well.

In embodiments of the invention, once the authorized user has providedthe necessary identification, the processor operates to cause thedesired substance to be dispensed or made accessible to the user. Theuser is also required to input the corresponding patient data so thatthe patient's chart and billing may be updated.

In alternative embodiments a user is enabled to access the system usinga scanner or similar reading device. Instead of inputting data into thedisplay terminal to identify himself, the user scans a machine readablecode on a badge, identification card or other article or body featurecorresponding to the user. For the dispensing of narcotics, whichrequires two authorized users, two users may scan their respectiveidentification item using the reading device. The reading devicepreferably includes an output device, such as a small screen, whichprovides messages to prompt users on the steps to be taken in a mannersimilar to that done when the user operates a display terminal. Thereading device also preferably has an input device thereon, such as analphanumeric keypad and/or function keys, which provides additional waysfor a user to provide inputs to the reading device in addition toscanning machine readable indicia.

In the alternative embodiment, storage locations such as shelves,drawers and/or refrigerator units preferably have machine readableindicia adjacent thereto. The machine readable indicia corresponds tothe location designator for the storage location, and the data stored inthe data store includes data representative of the type of medical itemstored in each location. The storage locations also preferably include afurther machine readable indicia thereon which is indicative that thequantity of medical items in the storage location is depleted. Thefurther indicia is preferably positioned in or adjacent to the storagelocation so as to be accessible by the reading device when the last ofthe medical items in the storage location has been removed.

The alternative embodiments including the reading device are useful forindicating various types of quantity conditions which occur at storagelocations. An exemplary form of the reading device includes a processorand a local data store therein which enables it to perform operations inaccordance with its programming, which is referred to herein as itsconfiguration. The reading device also produces transaction messageswhich are sent to other components of the system.

Certain types of medical items are not tracked or billed to patients.Such items may include aspirin, cotton swabs or bandages. Items of thistype may be stored in an open storage location such as open shelving andare available for any user to take. The storage locations for items thatare not tracked to patients are preferably marked with machine readableindicia of a type that is visibly distinguishable to a user from indiciafor storage locations holding items that must be tracked and billed topatients. The storage locations for items that are not tracked topatients are preferably marked to show a desired level or quantity (a“par value”) of medical items that should be kept in the storagelocation. If the level of medical items in the location drops and a userobserves that it is below par value, the user may scan the indicia withthe reading device. The reading device is preferably configured to treatthe scanning of indicia corresponding to a storage location, absentpreviously inputting data related to a user or a patient, as indicativeof a quantity condition at the location which corresponds to the storagelocation being below par value.

Alternatively, when all the medical items have been removed from thestorage location the user may operate the reading device to read thefurther indicia adjacent the storage location representative of thecondition that all the medical items in the location have been depleted.Such a condition is an alternative quantity condition which causesdifferent signals to be generated by the system from those correspondingthe first quantity condition. Transaction messages comprised of signalsare produced by the reading device corresponding to the differentquantity conditions. These transaction messages are sent to othercomponents of the system, and in the case of messages which indicatethat a storage location is below par value or depleted, are responded toby restocking the storage location with an additional quantity ofmedical items.

In alternative embodiments the reading device can be used for trackingmedical items taken for use by patients. A user may log into the systemusing the display terminal or by using the reading device to read theiridentification card, badge, other identifying article or feature. Mostusers of the system who are nurses or medical technicians performactivities which are primarily the dispense of medications for use bypatients. The data store preferably includes data representative of thedispense function as the function associated with such users. The userwill be considered by the system as performing this function unless theuser provides an input to the reading device that indicates that he orshe is going to perform a different function.

In one form of the system, once the user has logged onto the system heor she may select a patient at the display terminal and may scan or readthe indicia at the locations from which medications are taken for thepatient. This will cause the information concerning the taking of themedications for the patient to be stored in the data store. If access tothe desired medication or medical item is controlled by an accesscontrol device, such as an electrical lock on a cabinet, a lock moduleon a refrigerator, or an electronic lock drawer, the reader can be usedto gain access to the medical items controlled by the access controldevice. The storage location or locations to which access is controlledby the access control device preferably includes machine readableindicia on its exterior. In operation of the described form of thesystem, when an authorized user is logged on the system, scanning theindicia associated with the access control device enables the user toaccess the medical items, such as by unlocking a lock or opening adrawer. The indicia corresponding to the locations from which themedical items are taken may then be read with the reading device. Atransaction message is generated which is used to update the informationin the data store. The transaction message preferably updates the dataconcerning medications taken for the patient, as well as the inventorystatus for medical items at the various storage locations from which theitems have been removed. The user can then select another patient at thedisplay terminal and repeat the process.

The system of the alternative embodiment of the invention alsopreferably has available in the data store not only data representativeof the patients who may receive medical items but also the medical itemsthat have been prescribed for use by such patients. This enablesprinting reports with a report generating device. Such reports mayinclude both human readable as well as machine readable indiciarepresentative of patients and their prescribed medications. In analternative form of the invention a user may use the reading device toselect a patient by reading the indicia corresponding to that patientfrom a report rather than selecting the patient using the displayterminal. The user may then scan the indicia from the storage locationsto indicate the medical items taken for the patient in the mannerpreviously described. Alternatively, the indicia corresponding to amedical item may be scanned from the report if access to such medicalitem is controlled by an access control device. For example, if the itemis stored in the interior of an electronic lock drawer, refrigerator ora dispenser, scanning the indicia on the report causes the system tooperate to make the item accessible to the user by opening the accesscontrol device to the storage location or by causing the item to bedispensed from the dispenser.

A user may select several patients and their associated medical items ina sequence using the indicia on a report. The reading device preferablyholds the information until the user indicates that they are done by“logging off” the system. This avoids slowing the system operation bytrying to send messages to other components of the system while the useris operating the reading device. After the user has logged off, thetransaction messages may be sent as a batch to the other components ofthe system. A user may log off the system by inputting a command throughthe input device such as the keypad on the reading device.Alternatively, a user may log off by scanning machine readable indiciawhich indicates that the user is logging off the system, or by a newuser scanning indicia associated with the new user. Alternatively, or inaddition, the reading device may be provided with a storage locationreferred to herein as a cradle, and a log off signal may be generatedwhenever the reading device is returned to its cradle. Of course inalternative forms of the system the reading device may send itstransaction messages as events are occurring rather than waiting untilafter a user logs off.

The reading device may in various embodiments be connected to theremainder of the system by a data line or may communicate its messagesthrough forms of wireless communication. Dispensers, drawers and othertypes of storage locations which incorporate access control devices inthe described embodiment are connected to the system by data lines.However in alternative forms of the system such devices may be connectedto the remainder of the system through wireless communication methods.Such dispensing devices may in further alternative embodiments include aprocessor and a memory which enables them to operate in an off line modeof operation. Such devices may then communicate with the rest of thesystem to periodically deliver information on dispensing or restockingactivities. This communication may be accomplished by data line,wireless communication methods or through an intermediate device whichcan receive data from the dispensers, store the received data, anddeliver it to the rest of the system. The intermediate device may havevarious portable or stationary forms, and in certain embodiments may bethe reading device or a device functionally similar thereto.

In exemplary embodiments of the invention medical items may be trackedas dispensed for a patient by a user and then further tracked throughthe giving of the medical item to the patient. For purposes of thisdescription “giving” a medical item to a patient refers to any use of amedical item for the benefit of a patient. In such exemplary embodimentsdata is stored indicating that the particular medical item has beengiven to the patient. This may be accomplished in exemplary embodimentsthrough inputs to a portable terminal which is carried by a nurse to thebedside of the patient. Data representative of giving particular medicalitems to the patient may be stored in the portable terminal by providinginputs. These may include manual inputs or inputs achieved by readingmachine readable indicia with a reading device. The machine readableindicia may include indicia on reports indicating what has beenprescribed for the patient, and/or indicia on a patient associated itemsuch as a label on a bed, badge, chart or wrist band. The data recordedin the portable terminal may be communicated to other components of thesystem, such as by wireless communications or through a physicalconnection. The data concerning the giving of the medical items is thenstored in the data store in correlated relation with the informationconcerning the respective patients.

Alternative exemplary embodiments of the invention include systems inwhich patients may dispense medical items directly from self servicedispensers. In such embodiments the patient is enabled to gain accessonly to their own prescription information. The patient is enabled toselect the prescribed items and have them dispensed. In situations wherethe patient is required to make payment for the dispensed items at thetime of delivery, payment may be made via credit or debit card.Computers connected in exemplary embodiments of the system may beoperative to determine from stored data, the insurance benefit plan andrules of the plan associated with the patient. This enables thepatient's benefits provider to be invoiced for any covered amount andthe patient's account to be charged only for any co-pay amount.Additional features are provided in connection with such aspects of thesystem to increase the probability that the patient properly receivestheir prescribed medications.

Alternative embodiments of systems of the invention may use a readingdevice for reading machine readable indicia which is used to facilitaterestocking of the system. Labels may be provided on storage locations toindicate a restocked condition. Alternatively, or in addition, reportscan be generated based on the data in the data store which shows thestorage locations which require restocking with additional items. Suchreports may include human as well as machine readable indicia showingthe item to be restocked, the storage location, the number of units tobe added, as well as an indication that a restock function is to beperformed. Users who primarily perform restocking functions may beprovided identification cards, badges or other associated articles orfeatures with machine readable indicia that identifies them, and thedata store includes data which indicates that the activity normallycarried out by such users will be a restock function unless otherwisespecifically indicated.

Users who restock storage locations may identify themselves to thesystem using the display terminal, or alternatively by reading theindicia from their identification card, badge, article or feature withthe reading device. Such users may indicate that storage locations havebeen restocked by scanning the machine readable indicia for a locationfrom a report or from the storage locations, or both, in accordance withthe configuration of the reading device. Numerical data concerning thenumber of items in inventory can be counted and input through the keypadon the reading device. The reading device is also preferably configuredto provide prompt messages on a screen or other output device, to guidea user through the restocking process.

In embodiments of the invention the dispensing and restocking processesmay also be accomplished through the interface of the display terminal,as well as by using the reading device. This enables users of the systemto accomplish their functions using either the display terminal or thereading device, and in the event one malfunctions, required activitiescan still be carried out. This ability to carry out functions throughthe reading device, the display terminal, or both working cooperativelyincreases flexibility and reliability of system operation.

In alternative forms of the system dispenser devices such as electroniclock drawers, refrigerators, cabinets and other types of dispensers mayaccept removable liners in the storage locations therein. The liners mayhold the type of medical item that is dispensed from the storagelocation and may be configured to enable removal of medical items fromthe liner either manually or mechanically in accordance with the normaloperation of the dispenser device. Open storage locations for medicalitems may also include removable liners in the open storage locations.

The use of the removable liners may be used to facilitate restocking thestorage locations. For example, each liner may be stocked with a firsttype of medical item in a stocking location such as in a pharmacy. Oncethe liner has been filled a removable lid may be installed to restrictaccess to the medical items held in the liner. Preferably a lockingmechanism such as a tamper indicating lock is used to hold the lid inengagement with the liner.

In one preferred embodiment machine readable indicia is applied to eachliner. The machine readable indicia includes information representativeof the storage location in which the liner is to be installed. Thisindicia may include data representative of a particular storagelocation. Alternatively the indicia may include only the type of medicalitem housed in the liner. The location in which the liner will beinstalled may then later be determined based on information stored inthe data store. The indicia applied in associated relation with theliner may be in the form of a bar code label applied to the liner or thelid. Alternatively the indicia may be applied in connection with atamper indicating seal which is part of the locking mechanism whichholds the lid and the liner together.

In one preferred form of the invention the indicia which is applied inassociated relation with the liners comprises a bar code. The bar codeis preferably produced using a printer in the restocking location. Thebar code indicia is preferably in the form of labels that may betransferred to the liners or tamper indicating tags associatedtherewith. A restock report may also be produced at the stockinglocation to indicate where the liners or the type medical item heldtherein are to be installed. This information is produced based oninformation stored in the data store which indicates where restocking isrequired.

In one preferred form of the invention the liners and lids areconfigured to be stacked in nested relation. One preferred configurationprovides for releasible engagement which restricts shifting of theliners as they are transported from the restocking location to thestorage locations in which the liners are installed.

Once the filled liners reach the area adjacent to the dispenser deviceor other location in which they are to be installed, the restocking useraccesses an interior area of the dispenser device, cabinet, refrigeratoror other storage location. This is done by the restocking user in theestablished manner for the system. This may include the restocking userlogging onto an appropriate device such as a data terminal or scanningdevice, which is done using indicia identifying the user.

In one preferred method of operation of the system a restocking user mayaccess storage locations by reading the machine readable indiciaassociated with the liner. Upon reading the indicia, information storedin the data store is used to determine the location corresponding to theindicia. For example if the indicia indicates the type of medical itemin the liner, the stored data is used to determine the storage locationin which that particular type medical item is stored in that particulardispensing area. The information in the data store may then be used bythe computer to provide the restocking user with access to thatparticular location. This may be done such as by unlocking the drawer inan electronic drawer module where that particular type of medical itemis stored. In alternative embodiments a user may gain access by scanninginformation off of the restock report which indicates where the linersare to be installed. In further alternative embodiments other approachesmay be used.

Once a restocker has gained access to the storage location where theliner is to be installed, the user generally must remove a previouslyinstalled liner from the storage location. This previously installedliner may contain medical items. The user unlocks the locking device forthe liner that is to be installed and removes the lid therefrom. Thismay be done either before or after the liner is installed in the storagelocation depending on the particular situation.

In some embodiments the restocking user may transfer medical items fromthe previously installed liner to the new liner. When this is doneinformation concerning the number and type of units transferred is inputto the system through an input device such as the display terminal or ascanner. Alternatively the previously installed liner may be securedwith the lid from the liner that has now been installed in the storagelocation. If the previously installed liner includes medical items thatare to be returned to the stocking location, the lid is preferablysecured to the liner with a locking device such as a tamper indicatingseal. The previously installed liners are then preferably returned tothe stocking location. If medical items were returned with thepreviously installed liners, the type and number thereof is checkedagainst the data stored in the data store to verify that no improperactivity has occurred.

In exemplary embodiments of the invention proper installation of the newliners in the storage locations may also be verified electronically.This may be accomplished by labeling the storage locations withidentifying indicia. This indicia may be representative of the locationor alternatively may include the type of medical item that is storedtherein. To verify that the liners are properly installed once access tothe storage location has been obtained, a restocking user reads thelocation identifying indicia from the location with a scanner. Acomputer then determines based on the information stored in the datastore whether the location in which the restocking user is installingthe liner is a proper location for the liner to be installed. If apossible error is detected, an appropriate signal is given so that theuser is alerted that they may be installing the liner improperly. Thisfeature may be particularly valuable when liners are being installed incabinets or refrigerator units where access to several storage locationsis controlled by a single locking mechanism. Likewise this feature isuseful when liners are being installed in open storage locations.

In embodiments of the invention, the system may interface with othercomputer systems such as the admission-discharge-transfer (ADT) computersystem that the hospital uses to track patients. This is a computersystem which is used in a hospital or clinic to track patient locationand activity. In addition, the system of the present invention may alsobe connected to the hospital information system (HIS) which is therecord storage facility of the hospital which maintains computerizedrecords concerning patients. The system may be interfaced to thepharmacy system which keeps records of medications prescribed for eachpatient. As a result, patient activity, record keeping, and billing maybe automated through the system of the present invention, along withinventory monitoring. Systems of the invention may also interface withor incorporate other networks and systems including databases andfinancial transaction systems for obtaining information and carrying outfinancial transactions associated with patient treatment activities. Thesystem of the present invention may also be used to produce a widevariety of reports from the data store related to patients, authorizedusers, physicians and various types of items used in inventory. Such asystem may also be integrated with an automatic ordering system so as totransfer supplies from one location to another where they are neededand/or to automatically place orders for additional supplies withvendors when supply levels reach a limit.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a side cross sectional view of an inventory monitoringapparatus called a hook register used in the system of the presentinvention.

FIG. 2 is a front cross sectional view of the hook register shown inFIG. 1.

FIG. 3 is similar to FIG. 1 depicting a medical item being removed fromthe hook register.

FIG. 4 is a partial cut-away top plan view of a further inventorymonitoring apparatus of the present invention called a box register.

FIG. 5 is a side elevation view of the box register shown in FIG. 4 asseen along line of FIG. 4.

FIG. 6 is an enlarged view of the circled portion VI shown in FIG. 5.

FIG. 7 is a side view of a lever used in the box register shown in FIGS.4 and 5.

FIG. 8 is a top plan view of the lever shown in FIG. 7.

FIG. 9 is a front view of an alternative box register.

FIG. 10 is a partial side view of the box register along line 10-10 inFIG. 9.

FIG. 11 is an enlarged side view of a switch and lever of the boxregister shown in FIG. 9.

FIG. 12 is a front, partial cut-away view of the lever and switch of thebox register shown in FIG. 9.

FIG. 13 is a schematic view of the system for monitoring and dispensingmedical items including the hook registers and box registers.

FIG. 14 is a top plan view of a dispenser mechanism for vials containingmedications.

FIG. 15 is a cut-away side view of the dispenser shown in FIG. 14 withthe gate members thereof in a first position.

FIG. 16 is a view similar to FIG. 15 with the gate members of thedispenser in a second position.

FIG. 17 is a side view similar to FIG. 16 with the gate members in athird position wherein a vial is dispensed from the mechanism.

FIG. 18 is a cross sectional view corresponding to the dispenser asshown in FIG. 15.

FIG. 19 is a side view of the dispenser mechanism corresponding to FIG.16.

FIG. 20 is a side view of the dispenser mechanism corresponding to FIG.17.

FIG. 21 is a side view of the dispenser mechanism and gate members inthe positions shown in FIG. 15.

FIG. 22 is a side view corresponding to FIG. 21 including hidden edgelines.

FIG. 23 is a side view of the dispenser mechanism with the gate membersin the positions shown in FIG. 16.

FIG. 24 is a side view of the dispenser mechanism corresponding to FIG.23 including hidden edge lines.

FIG. 25 is a side view of the dispenser mechanism with the gate membersin the positions shown in FIG. 17.

FIG. 26 is a side view of the dispenser mechanism corresponding to FIG.25 including hidden edge lines.

FIG. 27 is a sectional side view of the dispenser mechanism shown inFIG. 14 located inside a medicine dispenser.

FIGS. 28 through 39 are windows displayed on the touch screen of thedata terminal in an embodiment of the invention, with FIG. 28 being apatient browser window.

FIG. 29 is a patient information window.

FIG. 30 is a patient usage browser window.

FIG. 31 is a med order browser window.

FIG. 32 is a supply browser window.

FIG. 33 is a kit browser window.

FIG. 34 is a kit information window.

FIG. 35 is a supply browser window selected to display trade nameinformation for the displayed medical items.

FIG. 36 is a supply browser window like FIG. 35 selected to displaygeneric name information for the displayed medical items.

FIG. 37 is a physician/route/site browser window selected to displayroute information for a medication.

FIG. 38 is a window through which a user may log into a displayterminal.

FIG. 39 is a non-itemized supply inventory window which is used toreview and input information concerning non-itemized medical items whichare not tracked to patients.

FIG. 40 is a schematic view of an alternative embodiment of the systemfor monitoring and dispensing medical items.

FIG. 41 is a label with machine readable indicia for identifying astorage location.

FIG. 42 is a label with machine readable indicia for indicating an outof stock condition at a storage location.

FIG. 43 is a label with machine readable indicia for indicating that astorage location has been restocked.

FIG. 44 is a label with machine readable indicia to indicate that thequantity of items in a storage location is below a desired level.

FIG. 45 is a schematic view representative of placement of labelssimilar to those shown in FIGS. 41 and 42 adjacent a storage locationfor a medical item.

FIG. 46 is a view of machine readable indicia which may be included in arestock report.

FIGS. 47-49 are a logic flow diagram showing steps that are carried outin the reading device of the alternative embodiment of the system shownin FIG. 40.

FIG. 50 is an isometric view of a refrigerator which holds medical itemsin an interior area, the refrigerator having a lock module mountedthereon.

FIG. 51 is a front view of the lock module and bolt supporting bracketshown in FIG. 50.

FIG. 52 is a partially sectioned view of the lock module.

FIG. 53 is a partially sectioned top view of the bolt supportingbracket.

FIG. 54 is a sectional side view of the lock module and bolt supportingbracket with the bolt shown in engaged relation with the lock module.

FIG. 55 is a schematic view of a system of the present invention whichmay be used to perform a restocking method for storage locations whichincludes removable liners.

FIG. 56 is an isometric view of an embodiment of a removable liner andlid.

FIG. 57 is a side cross sectional view of a drawer in an electronic lockdrawer module, shown in an extended position shown with a removableliner installed therein.

FIG. 58 is a transverse cross sectional view of a removable liner and adivider installed in the removable liner.

FIG. 59 is a side view of a first end of a liner and an engaged lidincluding the engaged hinge parts thereof.

FIG. 60 is a side view of a pair of liners and lids shown in stackedrelation.

FIG. 61 is a top plan view of a lid with a portion of an overlying linershown thereon in phantom.

FIG. 62 is a schematic view of an alternative form of a system of theinvention similar to that shown in FIG. 40 which includes additionalfeatures for tracking the giving of medical items to patients.

FIG. 63 is a schematic view of an alternative form of a system of theinvention similar to that shown in FIG. 40 which includes additionalfeatures for giving medical items to patients through self servicedispensers.

FIGS. 64-67 are a flow chart schematically representing logic flowutilized in connection with the operation of the system represented inFIG. 63.

BEST MODES FOR CARRYING OUT INVENTION

Referring now to the drawings and particularly to FIGS. 1 and 2, thereis shown therein a first embodiment of an inventory monitoring apparatusfor use in the present invention referred to as a hook register andgenerally designated by reference numeral 10. Apparatus 10 includes anelongated housing 12 including an upper wall 14, a lower wall 16, sidewalls 18 and 20, a front wall 22 and a rear wall 24. Housing 12 may beformed of any suitable durable material such as plastic or metal. A clipassembly 26 or similar attachment mechanism is desirably carried by aflange 28 of rear wall 24 whereby the housing may be detachably fastenedto a rail or similar support structure 30 affixed to a wall 32 or likesurface. As will be discussed in greater detail hereafter, rail 30 mayalso carry a communications bus 34 or other suitable means forelectrically connecting the apparatus 10 to a similar apparatus and to aremote computer and data terminal.

An object support means is designated by reference numeral 36. Asillustrated, the object support may assume the form of an elongatedrigid or angled rod which may be suitably formed of metal or plastic. Ashorter leg 38 of the object support means is affixed such as bythreaded fasteners 40 to the rear wall 24 of housing 12. A longer leg 42of the object support means extends generally longitudinally of thehousing 12 and is capable of supporting a plurality of objects 44. Thus,according to the first embodiment, object support means 36 resembles anelongated peg or rod which suspends objects 44 from holes orperforations 46 provided therein (see FIG. 2). The longer leg 42 ofsupport means 36 also desirably is formed with a raised portion 42A toprevent the objects from unintentionally sliding off the object supportmeans.

It will be appreciated that hook register 10 finds beneficial usage witharticles or objects which are suitable for suspension and whoseinventory it is desirable to monitor. Typical items may include packagescontaining medical items such as drugs, medical equipment, supplies,including for example, catheters and guide wires for angioplasty orother medical items which should be strictly and accurately monitoredbecause of theft, safety, critical need or other concerns. For thisreason, the object support means may assume any form necessary ordesirable to support the objects supported thereby. That is, the objectsupport means may be configured as a rack, multiple hooks or pegs orsimilar cantilevered members, a tee bar or other such equivalentconstructions.

A switch actuating means 48 desirably configured as a pivotable lever ismounted generally at its midpoint to housing 12 by a pivot pin 50. Inthe preferred embodiment, a first end of lever 48 projects through anopening 52 in lower housing wall 16. It is also contemplated that lever48 may be adapted to project through an opening similar to opening 52and may be provided in any other wall of housing 12 so long as thosecomponents necessary for the proper functioning of the apparatus 10 arecorrespondingly repositioned to accommodate the desired orientation andoperation of lever.

A second end of lever 48 is connected to suitable biasing means 54 whichin the preferred embodiment is a spring. In the preferred embodiment,the biasing means is a tension spring, however in other embodimentsbiasing means such as torsion springs, compression springs, elastomericmeans or the like may be used. The biasing means normally biases thelever to an “inoperative” position in which the lever extends generallytraverse to the longer leg 42 of the object support means 36 of the hookregister as depicted in FIG. 1.

It is important that the first end of lever 48 sufficiently project fromhousing 12 whereby it may be contacted and displaced by a medical item44 which may be either added to or removed from the object supportmeans. To assure that the lever will interfere with the passage of anobject, either into or out of a location on the object support means, afirst end of lever 48 is provided with a notch 56. Notch 56 isconfigured to receive the longer leg 42 of the object support means 36therein. As a result, when a medical item is removed from its storagelocation on the object support means, the object contacts and thendisplaces the lever so as to rotate it outward. The object then passesthe lever and once this occurs the biasing means 54 returns the lever tothe inoperative position.

A printed circuit board 58 is mounted in the interior of housing 12.Apart from certain circuitry components specifically identified belowwhich are essential to provide an adequate appreciation of the operationof the hook register, it will be understood that circuit board 58includes printed circuitry and other circuitry components.

Electrical switch means are supported by and electrically connected tothe circuit board 58. During operation the switch means serve as part ofa sensor that generates signals indicative of the placement of objectsinto the storage location on object support means 36 or removal of suchobjects from the storage location. The preferred embodiment of the hookregister utilizes a pair of switch elements 60 and 62 as the electricalswitch means. In the preferred embodiment, the switch elements areHall-effect sensors which change states (off-to-on) when a magneticfield is detected within close proximity. Lever 48 carries a compactpermanent magnet 64 which serves as an actuator means. The magneticfield produced by magnet 64 is capable of being sensed by switches 60and 62 to affect changes in their status. The signals indicating changesin the status of the switches are detected by a signal processingcircuit 65 which converts the signals to an appropriate form to bereceived and counted by a microprocessor 66. The microprocessor 66 inthe hook register serves as a counter which stores a count therein aslater described.

Operation of the hook register 10 is graphically represented in FIG. 3.Specifically, the object 44, which is preferably a medical item, isshown at the instant in time when it has fully deflected the lever 48against the force of the biasing means 54 and has just passed the firstend of the lever. At this moment, the permanent magnet 64 is pivotedinto a substantially facing relationship with magnetic field detectorswitch 60. Switch 60 is triggered upon detection of the magnetic fieldin proximity to the switch element and generates a signal indicatingthat one object unit has been removed from the object support means 36.Once the medical item has passed off the object support means, thebiasing means returns the lever to the inoperative position.

Similarly when a medical item is placed on to the object support means36, the lever 48 is pivoted in an opposite direction. This causes thepermanent magnet to trigger the magnetic field detection switch element62. This generates a signal indicating that one object unit has beenadded to the storage location on the object support means. Although inthe preferred embodiment magnetic field detection switches are used,other suitable switches such as three-way toggle switches, photosensors, optical encoders, capacitive or inductance sensors and the likemay be employed as sensors to achieve and generate the additive andsubtractive article registration signals. Likewise, the switch actuatingmeans may assume forms other than a pivotable lever depending on thetype of medical item and storage location involved. For example, alinearly reciprocal lever, a flexible flap or noncontact type sensorsmay be used in other embodiments.

The microprocessor 66 receives through signal processing circuit 65 thesignals generated by switches 60 and 62. The microprocessor containssoftware programs which record and count the state of the switches eachtime a change is detected. The number and direction of the changes arecounted and stored as a count in the microprocessor. In addition, themicroprocessor includes a computer program that enables it to be resetupon receipt of signals from a remote location. In the preferredembodiment, the microprocessor also has stored in association therewitha location identifying indicator that is representative of a numberand/or other data uniquely associated with the particular hook register.Each hook register and other dispensing apparatus in the system of thepreferred embodiment has a location identifying indicator associatedtherewith.

The electronic circuitry of the inventory monitoring apparatus also hasthe ability to communicate its count information to other components ofthe system of the present invention. In each hook register, theprocessor 66 is connected through a ribbon cable 68 which is connectedwith an electrical coupling 70. Coupling 70 electronically couples witha communication bus 34. In this manner, circuit board 58 is enabled toreceive power from a remote power source and is enabled to transmit andreceive data through communication bus 34.

The operation of the hook registers 10 in the inventory monitoring anddispensing system of the present invention is best shown with respect toFIG. 13 Each of the hook registers is connected to the data bus 34. Eachof the hook registers is connected to the data bus 34, which isconnected to a hook controller shown schematically as 72. Hookcontroller 72 includes a processor and a data store therein which areoperable to communicate with each of the hook registers 10. The hookcontroller 72 is operable to periodically poll each of the hookregisters 10 on the data bus. The hook controller reads and receives thecount information in each of the hook registers and stores it inconjunction with the location identifying information associated withthe particular hook register from which the count was received. Afterthe reading of the count information in the register and transmission ofthe data to the hook controller 72, the count information in themicroprocessor 66 may be erased so a new count can be started.Alternatively, the microprocessor 66 in the hook register may beprogrammed to store the count information and the time each such countwas generated for a period of time while generating new countinformation. This can be done to assure that usage of items from anyhook register can be recovered even in the event of the failure of ahook controller. While FIG. 13 shows only four (4) hook registersconnected to controller 72, it will be understood by those skilled inthe art that many more hook registers may be so connected on the databus.

As a result of polling each of the hook registers 10, the hookcontroller 72 has in its associated processor and data store the countof units taken or added in conjunction with the identifying informationassociated with each hook register. The hook controller 72 is connectedby a further data bus 74 to a data terminal 76 sometimes referred tohereafter as a display terminal. Of course other hook controllers andcontrollers connected to other types of registers may also be connectedto data bus 74. The data bus 74 is used to transmit and receiveinformation from the connected controllers to the data terminal 76.

Data terminal 76 includes a display screen 78 which serves as a dataoutput device. In the exemplary embodiment, screen 78 is a “touchscreen” of the type known in the prior art wherein a user may input databy placing a finger adjacent to icons displayed on the screen. Sensorsoverlying the screen sense the position of the finger and convert it toinput data. As a result, touch screen 78 serves as a graphical userinterface which includes a data input device as well as a data outputdevice. In other embodiments other types of input devices and outputdevices may be used. Data terminal 76 in the preferred embodimentfurther includes a card reader 80. Card reader 80 may be used to readdata encoded on a magnetic stripe of a user's identification card. Ofcourse in other embodiments of the invention other equivalent readermeans for reading coded objects or for reading a user's features such asfingerprints or retina pattern may be used depending on the level ofsecurity desired.

In the operation of this embodiment of the invention, a medicaltechnician who wishes to operate the system and remove medical itemsfrom the hook registers 10 operates the display terminal. The terminalscreen outputs a visual prompt for the user to identify himself orherself to the system by input of identifying data. In certainembodiments, the identification may be accomplished by the userinputting an identification number assigned to the user by touching theappropriate numbers on a graphical keypad presented on the screen of thedisplay terminal such as shown in the user log-in screen in FIG. 38. Inother embodiments, the user may be requested to swipe their card in thecard reader so that the magnetic stripe thereon may identify the user tothe terminal. In embodiments where high security is required, a user maybe requested to input both their card and a personnel identificationnumber (PIN) into the display terminal. The PIN has a predeterminedrelationship to the data on the card, and the data terminal may beoperated further only if a proper card and PIN are input.

When a user enters their identifying information at the displayterminal, the display terminal communicates through a local area network(LAN) 82 to a remote computer 84 which includes a processor and a datastore therein schematically indicated 85. Computer 84 may have greaterand faster processing capabilities and more memory than a displayterminal. The computer 84 has stored therein or in another computeroperatively connected therewith, information records associated withauthorized users. If the data input by the user at the display terminalcorresponds to a record for an authorized user, then the displayterminal will enable the user to operate the system. In alternativeembodiments of the system, one or more display terminals may have theadditional processing capabilities and the additional memory to performthe functions of computer 84. In such cases the functions performed bythe computer 84 may be distributed among the display terminals, or amonga network of numerous display terminals and computers, each of which hasan associated data store. It should be understood that unless otherwiseindicated, for purposes of the invention a network of operativelyconnected computers and data stores is the equivalent of a singlecomputer with a data store operatively connected thereto.

Upon further use of the display terminal, the user may access certaininformation about patients, medical items prescribed for use bypatients, procedures or physicians which is stored in records in thedata store of the computer 84 or other computers connected to computer84 through a local or wide-area network. In the preferred embodiment,the stored records include information about patients. The user mayselect a particular patient at the display terminal. This is preferablydone by the user scrolling through a displayed list of patient namesusing “keys” or “buttons” presented graphically on the touch screen. Thepreferred embodiment of the input device includes appropriateprogramming of the display terminal to include a highlighting deviceresponsive to a user bringing a finger adjacent to an area of the touchscreen indicating the patient or other data selected. The selected itemis highlighted to indicate it has been selected and further processingwill use the highlighted data. However, other input devices forselecting a patient name and other input data may also be used.

In one preferred embodiment, the display terminal displays a patientbrowser window 222 shown in FIG. 28. The patient browser window includesa list of patients. These patients are preferably patients that areassigned to patient rooms or other areas assigned to the displayterminal through programming in the display terminal or the computer 84.Alternatively, the display terminal or connected computer may beprogrammed to display a list of all patients in an institution at thedisplay terminal.

The patient browser window includes a previous page button 224 and anext page button 226 that enables a user to review or “scroll” throughthe stored list of patient names which covers several “screens.” Ofcourse, the “buttons” are preferably areas on the touch screen producedby the display to direct the user to touch an area which causes thedisplay terminal and/or connected computer to execute a particularfunction.

Patient browser window 222 further includes an add/find button 228. Theadd/find button 228 enables a user to either add a patient to the systemor to find a patient already in the system. Upon pushing the add/findbutton 228 the user is presented with another screen which prompts theuser to indicate whether they wish to add a patient or look for apatient who is already in the system, perhaps in another area of theinstitution. Further screens are presented based on the selection inputby the user. For example if the user wishes to find a patient, a screenwill request the user to input information about the patient such as thelast name. The user may be provided with a representation of a keyboardon the touch screen for this purpose or the display terminal may beconnected to an alternative input device such as a keyboard. Uponcompletion of the input of information, the user indicates that theinput is complete through the input device. The connected computers arethen operative to attempt to find records related to such a patient anddisplay the information on the touch screen.

Alternatively a user may press a sort button 230 to attempt to find apatient. The display terminal and connected computers are operative tosort the list of patients by name and display the sorted list on thetouch screen of the display terminal as shown in FIG. 28. Touching thesort button changes the manner in which patients are displayed on thetouch screen. For example, touching the sort button may cause it tochange the screen so that patients are displayed sequentially by room.The designation on the sort button 230 correspondingly changes as it istogged to indicate how patients are being displayed.

Alternative displays may also be provided in connection with the sortbutton 230 by programming the computer and the display terminal to sortand display patient data from various patient records in different ways.These may include for example sorting patients by area or ward, byphysician, by gender and in other ways that are useful to users of thesystem. Each time the sort button 230 is touched or “toggled” a newsorted display of patients or information is provided on the touchscreen and the designation on the sort button changes to correspond withthe method of sorting. The sort button repeats the sequence after it hasbeen toggled through all the sort options.

Returning to a discussion the functions associated with add/find button228, after first pressing this button the user is presented with anotherscreen where they may indicate that they wish to add a patient. Byproviding this indication to the display terminal through an input, theuser is prompted by screens presented on the display terminal to inputthe information needed concerning the new patient. The user can inputthe information through an input device such as a representation of akeyboard on the touch screen of the display terminal, or through aninput device such as a keyboard attached to the display terminal.

The display terminal and connected computers are programmed to promptthe user to input the necessary information to add at least one recordfor the patient to the database of the system. The inputs may alsoinclude optional information about the patient as may be available.After inputting the information the display terminal prompts a user toinstitute an “enter” command which adds the patient and associatedinformation to the system.

In response to the patient information being entered, the connectedcomputers are operative to establish records for the patient inaccordance with their programming. They are also operative to establishprogrammed correlated relationships among records and/or items of storeddata related to the new patient. Further in accordance with programmingof the system, the system may prompt users of other types of terminalsor other data input stations to generate records or input data intorecords concerning this new patient.

Upon finding the desired patient name in a patient window such as window222, the user designates that patient's record by touching the patient'sname on the screen. Thereafter, the user may remove medical items fromthe hook registers that are needed by that patient. When this occurs,the number of units of each item removed from a particular hook registeris stored as a count in the microprocessor in each hook register. Thisinformation is then transferred to the hook controller 72 when the hookregister is polled, and is thereafter transferred to the data terminal76 when the hook controller 72 is accessed through the data bus 74 bythe data terminal. As a result, data representative of both the patientand the location and number of units of medical items used for thatpatient is available in the data terminal.

When the user signs off the data terminal which is done by pushing alog-out button 232, or selects another patient (indicating that theitems for the prior patient have been taken), the data terminalpreferably transmits the information corresponding to the counts andlocation numbers of the items used for the selected patient through theLAN 82 to the data store in the computer 84 or another operativelyconnected computer or data store. Alternatively the data terminal may besending the data while the user is logged on. The computer 84 functionsto correlate the count and location numbers with a medical item recordwhich indicates the types of items stored and the location. Thisprovides an indication of what was used for the patient. In addition,the processor and memory in the computer 84 serve to update the recordrelated to the patient to indicate that the items taken were used forthe patient so that the patient may be charged therefore. The locationrecords related to medical items preferably includes or may bereferenced to pricing information so that patient may be automaticallybilled. In addition, the computer 84 also updates its records concerningthe number of medical items remaining in storage in each location.

The computer 84 is operable in this embodiment to maintain a continuousreal time record of how many units of medical items are stored in eachof the locations. If the number remaining in any location has reached alower limit, the computer 84 is programmed to provide a warning of theneed to replenish the supplies at that location to an administratorterminal or workstation 86. The administrator's workstation 86 is also acomputer with a processor and data store and is connected through theLAN. It has input devices such as the keyboard and mouse shown and anoutput device such as the screen shown. The terminal 86 may also haveother input and output means such as a touch screen, spoken wordrecognition, audio output or signal outputs connected to printers orother devices. Of course, the need to replenish the supplies may beindicated on the screen at the administrator's workstation or in otheroutput locations including the data terminals in the area where the hookregisters need to be replenished.

In other embodiments, the data terminal may be used to help medicaltechnicians or nurses select medical items for patients. The computer 84or other connected computers have associated data stores which includerecords which contain information on medications prescribed for patientsor medical items to be used in the treatment of patients. The computer84 also preferably includes records related to medical procedures aswell as physicians in its data store. This information may be accessedat the display terminal by the medical technician or nurse who isobtaining supplies for use in such a procedure. By accessing the storeddata records related to the procedure, the technician can read a recordwhich includes information such as the items that are normally used insuch a procedure. As a result, the technician may note these items andmay remove them from the hook registers while viewing the procedurerecord to ensure that everything normally needed is transferred to theoperating room. In addition, the procedure records may be accessed inconnection with a physician record related to a physician who willperform the procedure. Such records may include additional medical itemsthat the particular physician requires to have present in an operatingroom when conducting a particular procedure. This may include additionalmedical items or particular types of medical items that the physicianprefers. It may also include convenience information such as theparticular type of music the physician prefers to have played in theoperating room during a procedure or other items that the particularphysician prefers to have available.

In other embodiments of the invention, computer 84 or other connectedcomputers may be programmed to have in its data store, and may providein response to a request at a display terminal, a schedule of proceduresin a particular hospital operating theater. This enables the medicaltechnician or nurse participating in the procedure to locate the patientscheduled for a procedure using the display terminal, and to accesstherewith the records related to the physician and the medical itemsthat will be needed for the procedure. As a result, the technician ornurse may go to the hook registers, obtain the necessary medical itemsand have them immediately charged to the patient's account.Alternatively, if medical items which are dispensed are involved, theitems may be simultaneously dispensed together. If after the procedurenot all of the items that were originally taken were used, the items maybe returned to inventory and credited to the patient's account ifappropriate. Alternatively, such items that are partially used may needto be wasted. This is generally done by the user identifying himself orherself to the display terminal 76 and again identifying the patient tothe system using the touch screen 78 in the manner previously described.Replacing the unused items back on the hook registers 10 automaticallycreates a record that such items were returned and the patient's accountwill be credited in the computer 84. Alternatively returned medicationsand wasted items are returned to designated areas and records thereofare generated and stored. Because of the large number of records thatare stored in the data store of the computer 84 and other connectedcomputers, a large number of reports related to inventory usage may begenerated. This can be accomplished by using database software such asParadox® in computer 84. Alternatively, relational database softwaresuch as Oracle® is preferably used. Further, because the inventory ateach location is monitored, messages requesting transfers of inventoryfrom areas where there are excess units to areas where there is a needcan be automatically generated by the computer and displayed at theadministrator's workstation. The computer 84 also operates to keep arunning tally in the data store of what has been used by each patient aswell as what has been taken by each user and used by patients of eachphysician. This further allows monitoring of usage and allow potentialabuses to be uncovered. The computer 84 is ideally programmed to lookfor patterns of dispensing activity that have been programmed into thecomputer's memory as potential abuses and to display a report thereof atthe administrator's workstation. Such potential abuses may includetaking particular items at abnormally frequent intervals. The computer84 may also be programmed to provide reports from the databaseconcerning what particular users have dispensed during a given timeperiod and what particular physicians have used or prescribed forpatients.

In the described embodiment of the system of the present invention, theadministrator's workstation 86 is used as a primary tool for themonitoring of inventory. The administrator's workstation is used toprogram the particular type of medical item stored in the location ateach of the hook registers and in other types of registers in thesystem. This is done by creating a record for each location in the datastore. The administrator's workstation is also used to set the level ofthe minimum acceptable number of units of each item at each location sothat an indication may be given of a need to replenish or transferstock. This is programmed as a minimum for each location, and anindication is given when the minimum is reached. Further, theadministrator's workstation preferably includes electronic orderingcapability so that when supplies of a particular item are reduced to aparticular level, a purchase order to replenish the stock is sentautomatically to the manufacturer. The ordering and source informationis also optimally part of or referenced with the associated record withthe item in the data store. As a result, the administrator's workstationis programmed so that when the quantity of an item on hand falls to aparticular level, an order is communicated to the manufacturer of theneeded item directly over a telephone or other data line via a modem,indicating electronically the item needed, an order quantity and a dateby which the items must be received. The order quantity data may bepreprogrammed or may be calculated automatically by the computer using aprogram that generates the order quantity based on rate of use.Likewise, the delivery date may be a programmed time period afterissuance of the order, but may also be programmed to be a rush order ifthe “on hand” quantity has fallen to a second lower level or if the userate is above a programmed level.

The administrator's workstation may also be used to establish recordsfor authorized users and to set varying levels of security forauthorized users at different types of display terminals. Although inthe described embodiment, the administrator's workstation is the primarycontrol for the system of the present invention as shown in FIG. 13, thehospital's other computer systems including theadmission-discharge-transfer (ADT) system 88 and the hospitalinformation system (HIS) 90 are also connected to the local area network82. This enables the patient data in the computer 84 to be input andoutput to the ADT system 88 and records relating to patient activity orother activities to be received from or stored in the HIS, which istypically the long term data storage facility related to patients. Thesystem is also preferably connected to other computer systems in theinstitution such as a pharmacy system 89 which provides information onmedications prescribed for such patients. The system may also beconnected systems in dietary and food services and in other institutionareas. Each of these systems may contain multiple processors and datastores which transmit selected data to and from the LAN 82. This enablesthe exchange of data throughout the hospital's computers whichfacilitates both record keeping, patient billing and monitoring of itsinventory.

The hook registers 10 which are optimally constructed for supportinghanging items are only one type of dispensing device that can be usedwith the present invention. FIGS. 4 through 6 reflect a furtherembodiment of an inventory monitoring apparatus designated by thenumeral 110. Apparatus 110 is called a box register as it is optimallyadapted to include storage locations for holding boxes or box-likearticles. Box register 110 includes an elongated housing 112 includingan upper wall 115, a lower wall 116, end walls 118 and 120, a front wall122 and a rear wall 124. Like housing 12 of hook register 10, housing122 may be fabricated from any durable material such as plastic ormetal. Although not shown, it will be understood that a clip assemblysimilar to clip assembly 26 of FIGS. 1 and 2 or a similar attachmentmechanism may be used to detachably fasten the housing to a wall.Alternatively, apparatus 110 may rest on a level shelf, tabletop orreside in a cabinet. Each box register 110 is connected to acommunication bus 74 (see FIG. 13).

With regard to the box register, in this embodiment, an object supportmeans is represented by reference numeral 136 which support means mayassume the form of a receptacle having at least one or preferably aplurality of compartments or object storage sites 138 which arelocations wherein medical items may be stored. In this embodiment,object support means 136 is constructed as a multiple compartment, heavygage, stiff metal wire rack including a pair of upright truss-like endwalls 139, a plurality of spaced apart storage site divider walls 140situated between and generally parallel to the end walls 139 and aplurality of transverse members 141 affixed to the end walls 139 anddivider walls 140. The end walls 139 are desirably secured by suitablemechanical fastening means 142, such as nuts and bolts or the like tolower wall 116 (as shown) or any other wall of the housing 112.

As shown in the figures, the object support means 136 is adapted tosupport objects 144 of substantially uniform dimensions (one of which isshown in phantom in FIGS. 4 through 6) in a substantially uprightorientation. For example, objects 144 may be generally uniformly sizedrelatively thin boxes or similar packages which may contain variousdesignated types of medical products. The object support means asillustrated is thus capable of supporting an object on four sidesthereof, i.e., the bottom, back and both lateral sides of the object(see FIGS. 4 and 5). In this fashion, an object 144 may be removed fromthe object support means 136 by lifting it forward (to the right asshown in FIG. 5) and/or upward. The bases of the divider walls 140 aresituated at a lower elevation than the upper wall 114 of housing 12(FIG. 5) whereby the objects 144 are caused to be tilted slightlyrearwardly such that the back sides of the objects maintain contact withthe rear of the object support means 136.

Although the described embodiment of the object support means 136supports the objects 144 such as boxes in substantially upright orvertical position, the present invention also contemplates rackgeometries whereby objects may be supported substantially horizontally,at acute angles or in a staggered array incorporating one or moreangular support orientations. Further, the spacing between the dividerwalls 140 need not be uniform in which case storage sites 138 ofvariable dimensions may be provided in the same object support means136. Of course the object support means 136, like housing 112, may befabricated of metal or from any high strength substantially rigidplastic or other suitable material.

Box register 110 includes switch activating means 148. The switchactivating means 148 includes one or more levers pivotally mounted at150 (see FIG. 6) to housing 112 in a manner described hereafter. Thelevers 148 correspond in number to the number of compartments 138 whichare the storage locations provided in the object support means 136. Afirst end of each lever 148 projects from the housing 112 into arespective one of the storage sites 138 and a second end of each leverextends into the housing as most clearly seen in FIG. 6. The first endof each lever protrudes from the housing for a distance sufficient to becontacted and displaced by an object 144 when such object is added tothe object support means 136. Biasing means later discussed return thelevers to inoperative positions upon removal of an object from thecorresponding storage site.

Referring to FIGS. 4 and 6, as is the case with the hook registersdescribed above, the box registers likewise have printed circuit boardstherein designated 158 one of which is shown. Circuit boards 158 aremounted in the interior of housing 112. Circuit boards 158 includeprinted circuitry and other circuitry components which are notillustrated or described in detail except to the extent necessary for aproper understanding of the present invention.

Electrical sensor means are supported by and electrically connected tocircuit board 158. The sensor means generate signals indicative of theplacement of an object onto and the removal of an object from the objectsupport member 136. According to the preferred embodiment, the sensormeans comprises one or more discrete force actuatable switches 160 suchas snap-type internally resilient dome switches or other type electricalswitches. Switches 160 are spaced apart along the length of circuitboard 158 and correspond in number to the levers 148 whereby the secondend of each lever operates a separate switch.

The switches 160 generate real time counting signals indicative of thetotal inventory of objects 144 carried by the object support sites whichare occupied and those which are unoccupied at any instant in time. Thuswhen a lever 148 is caused to pivot in one direction by an object thatis placed into a storage location, the second end of the lever closesits respective switch 160. This is reflected by the solid line image oflever 148 depicted in FIGS. 5 and 6. Switch 160 in turn generates aregistration signal indicating that an object has been placed into thestorage location and at which storage site the object has been added.

Conversely, when an object is removed from the object support means, thebiasing force from the internal resilience of the dome switch 160returns the lever to its inoperative position as is reflected by thedash line image of lever 148 illustrated in FIGS. 5 and 6 whereby theswitch is open. In this position, the switch generates a registrationsignal which reflects that an object has been removed from the storagelocation. Additionally, if mechanical switches other than dome type orother similar switches possessing internal resiliency are employed asthe electrical switch means, then biasing means such as springs orelastomeric means may be provided to assure that the switches changeelectrical condition upon removal of objects from the object supportmeans 136. Alternatively, certain switch types have built-in springswhich provide the biasing force. Although dome type switches are used inembodiments of the box registers, other suitable sensor means such astwo-way toggle switches, momentary contact switches, photo sensitiveswitches, capacitive or inductance sensors and the like may be employedto affect the generation of additive, subtractive and object locatingregistration symbols.

FIGS. 7 to 8 show on an enlarged scale a lever 148. The lever desirablyincludes a pair of opposed notches 161, 162 which generally separate thelever into its first and second ends and, in cooperation with matingslots provided in the front wall 122 of housing 112, establish thepivotal connection 150 of the lever relative to the housing. Further,each lever 148 is preferably provided with a downwardly sloping lip 163at the leading edge of its first end to facilitate insertion of theobjects 144 into the storage sites 138.

The signals indicating changes in the status of the switches 160 aretransmitted by wire or other acceptable signal conducting means 164whereupon they are detected by a signal processing circuit 165 whichconverts the signals to an appropriate form to be received and countedby a microprocessor 166. The microprocessor 166, like microprocessor 66of the hook registers 10 described above, contains software programswhich record the state of the switches each time a change is detected.The microprocessor 166 also counts and stores a count indicative of thenumber and direction of changes in state as they occur. Further, themicroprocessor 166 includes the unique location identifying indicatorassociated with each of the storage locations in which any changes inthe presence of a medical item have occurred. Alternatively, themicroprocessor 166 may keep track of the times such changes haveoccurred.

While not illustrated it will be appreciated that the hook and boxregisters are preferably remotely powered through the associated busconnections. In other embodiments they may be locally powered. Further,in other embodiments the registers may include LED or LCD displays onthe registers for indicating the powered condition of the particularregister or the fact of a change in the status of inventory items at thelocation. Of course suitable LED or LCD indicators may also be used forother purposes such as indicating the particular type of item to bestored, that the register is in a restocking mode, or that the amount ofinventory stored in the location has fallen below a critical level. Thisis accomplished by programming in computer 84, or programming in theother processors connected to LAN 82 to output such an indication undersuch conditions.

An alternative embodiment of a box register 110′ is shown in FIGS. 9through 12. Box register 110′ is similar to the previously described boxregister 110 except as expressly noted herein. The box register 110′includes a plurality of compartments 126 which are separated by dividerwalls 128. Each compartment has located therein a lever 130, which ismovable about a pivot 132 (see FIGS. 11 and 12). The lever includes anobject engaging leg 123 and a switch actuating leg 133. The leg 133 isengageable with an actuating projection 134 of a switch 135. The switch135 includes an internal spring which biases the actuating projectionoutward from the switch. The switch operates to change its electricalcondition when the actuating projection is depressed.

Objects or items such as boxes holding medical supplies are stored inthe compartments 126. The presence of an object in the compartmentengages the object engaging leg 123 and moves the associated lever 130to the position shown in phantom in FIG. 11. In this position lever 130is in abutting relation with a stop member 152 which bounds the rear ofthe compartment. The stop 152 prevents the object engaging leg of lever130 from being rotated rearward beyond the position shown in phantom.When object engaging leg 123 is in engagement with stop 152, switchactuating leg 133 depresses actuating projection 134 of switch 135resulting in the switch having a first electrical condition.

Upon removal of the box or other object from the compartment, actuatingprojection 134 moves outward in response to the biasing force of theinternal spring as the object disengages lever 130. Outward movement ofactuating projection 134 causes switch 135 to change its electricalcondition. As in the earlier described embodiment of the box registerthis change is noted in conjunction with the location information in thebox register's associated microprocessor, similar to microprocessor 166.

Although the box registers shown are a single tiered rack, the objectsupport means may comprise a multi-tiered rack or a plurality of rowsand/or columns of cubicles whereby each of the storage sites or cubiclesmay be appropriately fitted with a switch actuating means such as alever.

In the preferred form of the invention, the box registers are connectedthrough bus 74 with the display terminal 76. The display terminalperiodically reads the count information in the microprocessor 166associated with each of the box registers and receives changes in thecount information associated with each of the storage locations in thebox registers.

A user may operate display terminal 76 to indicate the appropriatepatient for which material taken from the box registers will be used inthe manner previously described with regard to the hook registers. Inaddition, the administrator's workstation is used in the setup of thesystem to assign the particular type of medical item to be stored ineach location in the box registers which is stored in a record incomputer 84. However, unlike the hook registers which may store asubstantial number of units of the particular type of medical item ineach location, a box register is adapted to store only one such item ineach location. Therefore, in some embodiments several adjacent locationsin the box register are designated for containing the same type ofmedical item.

As is also the case with the hook registers, a user of the system who isreplenishing inventory to the box registers may operate the displayterminal to so indicate using the touch screen data entry device that heor she is replenishing inventory. In this case, the records in computer84 will be updated to indicate the units of inventory added in each ofthe storage locations. No patient is credited for the items stocked inthe locations and a record in the data store concerning the number ofsuch items on hand but not yet placed for use in a location is alsoupdated. In alternative embodiments, a bar code is applied on thevarious items stored in the hook and box registers. A bar code reader orscanner shown schematically as 104 in FIG. 5 is positioned in the hookand box registers so that the code on the item is read as it is placedor removed from a location. The bar code scanner generates signals thatare interpreted by software for reading bar codes which runs in computer84 or another terminal in the LAN 82. A data store associated with thesoftware includes information which correlates each bar code identifierwith a particular medical item. This provides a check that the itemactually stored or taken is the type that is recorded as stored in thatlocation. If an error is made an alarm may be given, either at theregister, display terminal and/or the administrator's workstation.Alternatively, the bar code on a the medical items may be used to “setup” the system, so that the system records the fact that a particularmedical item is stored in a particular location as a result of havingread the bar code thereon as the item is placed therein. This avoids theneed to program the administrator's workstation with this information.The bar code scanner can be provided in addition to the indicator whichindicates an item is added or removed. Alternatively, the bar code maybe read as each item is removed from a location on a hook or boxregister and the use for the patient of the item recorded directly inresponse to reading the bar code signals and identifying the patient atthe display terminal.

The information included in the data store with respect to particularitems may also include a date by which perishable items must be used.The user stocking such items in the locations can input such informationusing the input device of the data terminal. Items having a limitedshelf life are preferably stored in the box registers where the “use by”date can be uniquely associated as part of the record for the only itemin the location.

The system can also be used with other types of devices that are used toindicate that an item has been taken for a patient. One such device is amanual input register where a nurse or other medical technician manuallyindicates that an item has been taken.

In one embodiment a manual register is structurally similar to boxregister 110′ except that it does not include compartments or levers.The actuating projections of the switches are connected to manuallyengageable buttons. The system is programmed so that the momentarychange in electrical condition of a switch resulting from depression ofa particular button represents the taking of one unit of a particularitem from storage. Preferably each button is labeled with indiciarepresentative of the item that it is associated with.

In the case of a manual register, the nurse or medical technician quesup the patient who will receive the items on the screen of the dataterminal and touches the screen to select that patient. The user pusheseach button on the manual register corresponding to the type of itemtaken. By pressing the button once for each unit of an item taken, datais stored in the microprocessor associated with the manual registerwhich is representative of the particular button location pushed and thecorresponding count associated with that button. This information iscorrelated with the patient record in the same manner as occurs with thehook registers and box registers.

The system of the present invention may also be used in conjunction withother types of dispensing devices. An example of such a device is anelectronic lock drawer 96. The electronic lock drawer may be used tostore narcotics or other articles, the use of which is highly restrictedand which are not suitable for storage in a hook or box type register ofthe type previously described. Alternatively, the electronic lock drawermay comprise a secure enclosure housing hook registers or box registersin its interior. The function of the electronic lock drawer is to holdthe restricted items and provide access thereto by opening a lockingmechanism of the unit only when a set of predetermined conditions aresatisfied. The electronic lock drawer is but an example of one of manypossible storage or dispensing devices which incorporate an accesscontrol device which selectively controls access to the storagelocations for medical items or which makes medical items accessible bydispensing them to a user.

In one embodiment of the invention the electronic lock drawer isconnected to and the opening thereof controlled through an adjacent dataterminal 98. Data terminal 98 is similar to data terminal 76. Dataterminal 98 is connected to the electronic lock drawer 96 and isoperable to unlock the lock thereto upon receipt of appropriate signalsfrom computer 84. Of course although only one electronic lock drawer isshown in connection with data terminal 98, additional electronic lockdrawers may be connected thereto.

In the preferred form of the invention, information about each type ofrestricted material housed in each electronic lock drawer is stored in arecord in the computer 84. To gain access to these materials a user mayfirst identify himself or herself to the data terminal in the mannerpreviously described. Preferably for highly restricted items, computer84 requires not only a user to input an identification card and PINnumber but also a second authorized user to input their coded card andPIN number. The purpose for requiring two (2) authorized users to bepresent to open the electronic lock drawer is so that the items removedand their disposition may be verified.

Preferably, the computer 84 has stored in the patient record,information about the medications that the patient has been prescribedor authorized to be given. As a result, the user may use the dataterminal to select the patient name and to request the opening of theelectronic lock drawer so the user may take the medication for thepatient. This is done using the touch screen of the data terminal as aninput/output device. Thereafter, upon proper input of a furtherauthorized user's verification information, the electronic lock drawerwill unlock in response to signals sent from the computer 84 to the dataterminal 98 and from the data terminal 98 to the lock drawer 96.Thereafter, the user may remove the medication from the lock drawer inthe presence of the verification user and reclose the unit. Upon theuser inputting a verification input to the data terminal that themedication has been taken, the associated record of use and the chargetherefore is automatically added to the patient's account by thecomputer 84.

It does not matter if a medication that is stored in the electronic lockdrawer is not listed as one the patient is authorized to receive in thepatient's records in the computer 84, the authorized user may stillaccess the electronic lock drawer. A user may input a request throughthe data terminal for a listing of medications available. In responsethe computer 84 outputs to the data terminal a listing of the availablemedications and the dosages. The computer may also provide informationon the location of each medication. The user may then select aparticular type of medication and then input through the data terminal arequest for a listing of patients which again is provided from therecords in the data store of computer 84. By selecting the patient whois to receive the medication (and when appropriate providing thenecessary verification from a co-authorized user) the appropriateelectronic lock drawer will unlock and allow access to the medication.Upon verification input to the data terminal from the user that themedication has been removed, the computer will charge the patient'saccount therefore by updating the patient's record. Of course as is thecase with the other medical item storage locations previously described,computer 84 also operates to keep track of the inventory of variousitems inside the electronic lock drawer 96 to assure adequate stock. Thecomputer is also programmed to record the users and verification userswho have removed items from the electronic lock drawer and the types ofitems taken so that any shortages or patterns of abuse may beautomatically noted. Further, as discussed previously, data terminal 98may be used to access information in the computer concerning proceduresand physicians so that items in the electronic lock drawer 96 may betaken to an operating theater in advance of a surgical procedure.

Of course data terminal 98 may be used like data terminal 76 to credit apatient's account for items returned from inventory as well as toindicate replenishment of inventory in the electronic lock drawer. If anarcotic substance is to be returned the computer is programmed to havea verification user verify the returns. Returns are preferably made intospecial one way receptacles so that returned items can not be removed byunauthorized persons.

Another type of dispensing device used in embodiments of the inventionare devices which provide storage for medical items under controlledenvironmental conditions. This is represented by a refrigerator 450shown in FIG. 13. Refrigerator 450 has an interior area which holdsmedical items of one or more types therein. Access to the interior areaof refrigerator 450 is controlled by a lock module 452. Lock module 452controls access to the medical items in the interior area of therefrigerator. The lock module 452 is controlled from the displayterminal 98. The operation of the refrigerator and the lock module isgenerally similar to that discussed for compartments in the electroniclock drawer 96. It should be understood that embodiments of theinvention may include subcompartments within the interior area of therefrigerator, and access to each subcompartment may be controlledselectively from the display terminal or from other computers within thesystem. The system may also have a plurality of refrigerators or otherenvironmentally controlled chambers, and access to each may becontrolled individually. This enables providing various levels ofsecurity for the different types of medical items housed in eachrefrigerator.

Access to the interior areas of the refrigerators is obtained by one ormore authorized users as required by the programming of the system. Thisis accomplished in the manner previously discussed in connection withthe electronic lock drawer. A signal from the display terminal 98 orother connected computer is sent to the associated lock module so as toenable the user to access the interior area of the refrigerator and themedical items held therein.

The refrigerator 450 and lock module 452 of one preferred embodiment ofthe invention are shown in greater detail in FIGS. 50-54. As shown inFIG. 50 refrigerator 450 has a door 454. Door 454 is a conventionalrefrigerator type door that includes a handle 456 on an exterior areathereof. Refrigerator 450 also has a body 458. Body 458 has an interiorarea or compartment which is maintained at a temperature below ambienttemperature suitable for the type of medical items intended to be housedtherein. It should be understood that the interior area of therefrigerator 450 in some embodiments may be a single storage location inwhich one or more types of medical items are housed. Alternatively theinterior area may be divided into several storage locations. Thesestorage locations may be open storage locations or may besubcompartments to which access is further controlled by electronic orother types of locking mechanisms. The preferred embodiment of theinvention provides for records to be maintained in the data storeassociated with the computer concerning the type and number of medicalitems stored in each storage location.

Door 454 in the embodiment shown may be swung open in the conventionalmanner so that authorized users may gain access to the interior area ofthe refrigerator. Access to the interior area is controlled by signalswhich are sent to the lock module 452. The lock module is mounted on anexterior surface of the body 458 in the embodiment shown. A bolt supportbracket 460 is mounted to an exterior surface of the door 454. As laterdiscussed bolt support bracket 460 is in connection with a bolt. Thebolt is normally accepted and held by the lock module 452 so as tomaintain the door 454 in a closed condition. The lock module 452 isoperative to release the bolt in response to an appropriate signal sothat an authorized user is enabled to access the interior area of therefrigerator.

The lock module 452 includes a key cylinder 462. Key cylinder 462 ispart of a manual unlocking mechanism that enables opening therefrigerator door 454 using a key. This provides an alternative way foran authorized user to access the interior area of the refrigerator inthe event of a failure which prevents the interior area from beingaccessed electronically or alternatively for emergency or restockingpurposes. The lock module 452 also includes a visual indicator 464. Thevisual indicator 464 in the preferred embodiment is an LED typeindicator which indicates that the lock module 452 has received thesignal which enables the door 454 to be opened. In alternativeembodiments other types of indicators or additional indicators may beused.

As shown in FIG. 52 the lock module 452 includes an enclosure 466. Theenclosure is secured to the exterior surface of the body 458 of therefrigerator by a plurality of fasteners 468. In the preferred form ofthe invention the enclosure 466 includes an exterior cover whichrestricts access to the fasteners after the enclosure 466 has beeninstalled on the refrigerator. The preferred form of the invention isretrofit to an existing refrigerator or similar device by attaching thelock module 452 onto the exterior of the device and adjacent to the doorthereof. Once installed using the fasteners 468 a cover is installed onthe enclosure so as to minimize the risk of tampering.

As shown in FIG. 52 the lock module of the preferred embodiment includesa pawl 470. The pawl is mounted in rotatable relation about a pivot 472.A spring 474 is attached to the pawl by a pin 476. The pin and saidspring are positioned relative to the pivot 472 so that the pawl 470moves through an over center position during its operation. This enablesthe spring 474 to apply a force which biases the pawl to rotate aboutthe pivot either in a first rotational direction or in an opposedrotational direction depending on the side of the pivot 472 on which thepin 476 is currently positioned.

The pawl 470 includes a recess 478 which receives a portion of the bolttherein in a manner later discussed. The recess 478 extends between afirst leg 480 and a second leg 482 of the pawl 470. A sensor 484 ispositioned to sense the position of second leg 482. Sensor 484 may be anoptical or a magnetic type sensor that operates to sense leg 482adjacent thereto. Sensor 484 is mounted on a bracket 486. Second leg 482includes a tapered surface 488 the purpose of which is later discussed.

As best shown in FIG. 54 pawl 470 includes a third leg 490. Leg 490 isbounded by a tapered surface as shown. A lever 492 includes a taperedstep 494. Tapered step 494 is engageable with third leg 490 of the pawl470 as shown. The tapered step 494 is part of a releasable catch forholding and releasing the lever and the pawl.

Lever 492 is rotationally mounted about a pivot 496. Lever 492 is biasedto rotate about pivot 496 in a counterclockwise direction as shown inFIG. 54 by a spring 498. A solenoid 500 is mounted in enclosure 466.Solenoid 500 includes an actuator rod 502 which is biased upwards asshown in FIG. 54 by a spring.

Actuator rod 502 is in connection with a pin 504. Pin 504 is engageablein a recess 506 in level 492. It will be appreciated that movement ofthe actuator rod 502 in a downward direction as shown in FIG. 54 rotateslever 492 in a clockwise direction. When the solenoid 500 deactivates,the actuator rod 502 rises and the lever 492 returns to the positionshown in FIG. 54 due to the biasing force of spring 498. The arrangementof the pin 504 and the recess 506 enable the lever 492 to be movableother than by solenoid 500. As shown in FIG. 54 cylinder 462 has aprojection 508 attached thereto. Projection 508 is rotatable when aproper key is inserted in the lock cylinder. Rotation of projection 508enables the projection to engage lever 492 at the opposite end of thelever from recess 506. Moving lever 492 upward with projection 508 fromthe position shown in FIG. 54, moves the lever in a manner comparable tosolenoid 500. This enables the lock module 452 to be changed from alocked condition to an unlocked condition in response to either a signalto the solenoid 500 or alternatively by a proper key inserted intocylinder 462.

As shown in FIG. 53 bolt support bracket 460 includes an interiorbracket portion 510. Interior bracket portion 510 is attached to anexterior surface of door 454 of refrigerator 450. The interior bracket510 is attached to the door by fasteners 512 only the heads of which areshown. In the preferred form of the invention the interior bracketportion 510 extends adjacent and is attached by fasteners to both thefront and side surfaces of the refrigerator door. Interior bracketportion 510 is attached to a bolt 514. Bolt 514 includes a pair ofspaced legs 516 and a transverse rod 518 which extends between the legs.

A cover 520 is mounted in overlying relation to the fasteners 512 so asto restrict access thereto. Cover 520 is engaged to the underlyinginterior bracket portion 510 by fasteners 522 only one of which isshown. As best shown in FIG. 50 the cover 520 and the bracket 510 areconstructed so that when the door 454 of the refrigerator 450 is closed,a surface 524 of the bolt support bracket is in close abutting relationwith the lock module 452. This restricts access to the bolt 514 andminimizes the risk of tampering therewith.

As shown in FIG. 54 when the refrigerator door is closed the bolt 514extends in the interior area of the enclosure 466 of the lock module452. In the locked position the rod 518 of the bolt 514 is positioned inthe recess 478 between the legs of the pawl 470. In this locked positionthe third leg 490 of the pawl is prevented from moving in acounterclockwise direction by engagement with the tapered step 494 onthe lever 492. Likewise the pawl 470 is prevented in this position frommoving in a clockwise direction by engagement with a pin 526 and thesensor 484 and its supporting bracket. This prevents the refrigeratordoor 454 from being opened.

When it is appropriate to open the door of the refrigerator a signalfrom the display terminal 98, or other operatively connected computer ordevice in the system, is transmitted to solenoid 500. The signal causesactuator rod 502 to move downward. This pivots level 492 in a clockwisedirection about pivot 496. The movement of lever 492 disengages thecatch holding third leg 490 of the pawl 470 engaged with the taperedstep 494. The bolt 514 is enabled to rotate pawl 470 in acounterclockwise direction about pivot 472. As spring 474 moves into anover center relation, leg 482 pushes on the bolt to bias the door towardthe open position.

The signal which activates the solenoid 500 also preferably causesillumination of the LED 464 so that a user is aware that therefrigerator door may be opened. In the preferred embodiment the signalfrom the display terminal lasts sufficiently long so that the user isenabled to open the door. Once the door has been opened the signal maybe discontinued. This is preferably done in response to the sensor 42sensing that the leg 482 of pawl 470 has moved away from the sensor.Alternatively the signal enabling opening of the refrigerator may timeout after a period set in the computer, such as 30 seconds, in whichcase the solenoid ceases to retract rod 502 and the lever 492 returns tothe position shown in FIG. 54.

In one preferred embodiment, whenever refrigerator door 454 is opened arecord concerning the event is made by the computer 84 and stored in thedata store 85. The record concerning the opening is preferably stored incorrelated relation with data representative of a user who caused thedoor to be opened. Other data correlated with the event preferablyincludes all of the data associated with other types of dispensers inthe system. This may include for example, the particular medications tobe taken from the interior area of the refrigerator, a particularidentified patient for whom the medications are to be taken as well aspricing and other information. Records concerning the numbers of medicalitems stored in the storage locations within the interior area of therefrigerator are similarly stored in the data store and adjusted basedon the data input to the display terminal.

In the preferred form of the invention the refrigerator door may remainopen despite the signal to the solenoid 500 being discontinued. In thiscondition the lock module 452 is in position ready to lock despite thedoor being open. When the signal to the lock module is discontinued thelever 492 returns to the position shown in FIG. 54. In this conditionthe pawl 470 is rotated counterclockwise from the position shown in FIG.54. As the door of the refrigerator is closed the bolt 514 moves intothe interior area of the enclosure 466. The rod 518 at the end of thebolt engages the tapered surface 488 on second leg 482 of the pawl andbegins to rotate the pawl 470 in a clockwise direction about pivot 472.Pawl 470 moves in a clockwise direction against the force of spring 474.The tapered surface of the third leg 490 engages and moves on thetapered step 494 of the lever 492 so as to move lever 492 clockwiseagainst the force of spring 498. Eventually as the bolt 514 moves inwardthe rod 518 of the bolt moves into the recess 478 of the pawl.Thereafter continued movement of the pawl 470 in the clockwise directioncauses the third leg 490 to move past the tapered step 494 on the lever492. This causes the lever 492 to move downward again holding the pawlin fixed engaged relation therewith.

As the refrigerator door is closed the leg 482 of the pawl again movesadjacent to sensor 482. This provides a signal which is received at thedisplay terminal 98. This signal indicates that the door has beenclosed. In a preferred embodiment of the invention the time of closingof the refrigerator door is preferably included as part of thedispensing event information in the data store along with the otherassociated information concerning the event. In alternative embodimentsof the invention the timing routine may be provided either in thedisplay terminal 98 or in the computer 84 so as to provide an indicationwhen the door of the refrigerator remains open beyond a set time period.Such a condition may be indicative of a problem or tampering with theunit. Such an indication may be given either at the display terminaland/or at other connected terminals in the system. In other embodimentsof the invention other approaches and techniques related to the trackingof items dispensed from the refrigerators and other controlledenvironmental chambers within the system may be used.

Another type of dispenser apparatus that may be used in the system ofthe present invention is the medicine dispenser 100 shown in FIG. 13.Medicine dispenser 100 is also used for dispensing medical items thatrequire high security such as narcotics. However, unlike electronic lockdrawer 96, medicine dispenser 100 is operable to dispense only theparticular item requested and to restrict access to all the other itemshoused within the medicine dispenser. As shown in FIG. 13 the medicinedispenser is connected to a data terminal 102 that is similar to dataterminals 76 and 98. The operation of the data terminal 102 inconjunction with the medicine dispenser 100 is similar to the operationof data terminal 98 in cooperation with electronic lock drawer 96. Thedifference in the use of the medicine dispenser is that in response toselection of the particular medical item (and the co-user verificationif required) the medicine dispenser will provide to the user theparticular medical item requested in the quantity requested. As aresult, the user is not required to locate the item as is required withthe electronic lock drawer. In addition, the level of security requiredfor dispense of medical items within the medicine dispenser can bevaried depending on the level of security required for the particularitem. As a result, for some items in the medicine dispenser 100 it maybe necessary only to verify that the user is an authorized user. Forother substances, only selected authorized users (and co-users) will begiven the substance.

The user interface of the display terminals of an embodiment of thepresent invention are shown in FIGS. 28 through 39. When the useraccesses the system using the display terminal the user usually beginswith the user log-in screen 302 shown in FIG. 38. In the user log-inscreen the user may input a user identification code using the “buttons”on the touch screen. The user may alternatively run their badge or otheridentification card through the card reader. After input of the useridentification code the user inputs their PIN. After a user successfullyaccesses the system through the display terminal for purposes ofobtaining medical items for a patient, they are generally presented withthe patient browser window shown in FIG. 28. From the patient browserwindow 222 a user may manipulate the previous page and next-page buttons224 and 226 respectively to display the patient for whom the medicalitems are to be taken on the screen. The programming of the displayterminal includes a highlighting feature which serves as part of aninput device of the display terminal.

A patient is selected by a user's finger being brought adjacent to thetouch screen which operates the display terminal to highlight thepatient name as graphically indicated by the highlighted band with apatient name in FIG. 28. Upon touching the patient name in addition tobeing highlighted, the patient name is also shown at the top of thescreen. This serves to identify this particular patient to the system asthe one for which medical items are being taken.

From the patient browser screen 222 a user is enabled to remove itemsfrom the hook or box registers, in which case the items will beautomatically indicated as taken for and charged to the patient.Similarly if an item taken for a patient is to be returned to a hook orbox register, highlighting the patient name on the patient browserscreen and replacing the item on the hook or box register results in thepatient's records and account being credited for the returned item.

From the patient browser screen 222, more information concerning theselected patient may be obtained by the user touching a patient infobutton 234. Touching the patient info button 234 causes the displayterminal to display the patient information window 236 shown in FIG. 29.Patient information window 236 shows information about the patient. Thiscan include vital statistics, the name of the treating physician,allergies that the patient may have and other information. In addition,the patient information window 236 also shows the assigned location ofthe patient in the facility. The patient information window 236 includesa close button 238 which a user presses to return to the patient browserwindow 222.

It should be noted that the patient browser window 222 as well as thepatient information window 236 include a help button 240. The helpbutton 240 is pressed by a user when they wish to obtain moreinformation about using the system features that are currently accessedon the displayed window. The display terminal and the connected computersystems are programmed appropriately to provide instructions concerningthe type of help most commonly needed when accessing the particularpatient windows. This makes the system easier to use and reduces theamount of training required before user may effectively operate thesystem.

From the patient browser window a user may choose to review the medicalitems that have been taken for the selected patient. To do this a usertouches a patient usage button 242. In response to selection of thepatient usage button, the computer and display terminal are operative todisplay a patient usage browser window 244 shown in FIG. 30. The patientusage browser window is operative to show medications and other medicalitems that have been taken for the patient as well as the amount andtime that each medical item was taken. The patient usage browser windowalso includes a return button 246 and a waste button 248. The returnbutton is selected in situations where a medication that has previouslybeen taken for a patient is returned without being administered. Thereturn button is used in situations where the returned item is acontrolled substance such as a narcotic or is another item that cannotbe freely dispensed or used for another patient. Selecting the returnbutton generally enables a particular return drawer mechanism to openinto which the medical item may be returned. By highlighting aparticular dose of medication on the patient usage browser screen andcompleting a return transaction, the status of a medication may bechanged from taken to return.

The waste button is used in situations where an item taken for a patientis to be returned in whole or in part and it cannot be used for anotherpatient. This includes situations where only a portion of the medicationis delivered and the balance is waste. Selecting the waste button 248also preferably opens a return drawer into which the wasted item may bedeposited. The patient's records are simultaneously adjusted accordinglyin the patient records and on the patient usage browser window.

The operation of the return and waste buttons 246 and 248, respectively,along with a return drawer used in exemplary embodiments are shown inallowed copending U.S. application Ser. No. 08/679,203 filed Jul. 12,1996, and allowed U.S. application Ser. No. 09/015,162 filed Jan. 29,1998, the disclosures of which Applications are incorporated herein byreference.

The patient usage browser window 244 also includes a discrepancy button250. The discrepancy button is used in connection with dispensingmedications as well as with the return and wasting of medications. Thediscrepancy button 250 is used by a user to indicate to the system thatsomething requested was not provided, or that an indication previouslyinput to the system is not accurate. Pressing the discrepancy buttoncauses the display terminal to display a window appropriate to indicatethe nature of the discrepancy. The patient usage browser window 244 alsoincludes a previous page button 224 and a next-page button 226 similarto those previously described for scrolling through the informationpertaining to the patient. Window 244 also includes a help button 240and a close button 238 like those previously described. The close buttonis used when the user is finished with the patient usage browser windowand wishes to return to the patient browser window 222.

Patient usage browser window 244 further includes a trade name/brandname button 252. Button 252 is operative to change the names of themedical items displayed on window 244 from the trade name to the brandname and vice versa. Button 252 may be toggled from one name for an itemto the other. This feature is available in a number of windows and isuseful for a user who may need to compare the brand name(s) of a medicalitem to the generic name and vice versa.

Trade name/brand name button 252 is enabled to provide this feature atthe display terminals responsive to records stored in data store 85 inwhich the generic names and brand names for medical items in the systemare stored in correlated relationship. The data store 85 furtherincludes in its records data indicative of whether each particular namefor the medical item is the generic or brand name. Multiple brand namescorresponding to generic names may be stored and displayed on thescreen. This feature enables a user operating the display terminal totoggle the display back and forth between brand name and generic name.In addition, the display terminal indicates in a header above the druginformation whether the generic or brand name information is beingprovided on the screen. Button 252 changes to the opposite designationto that being displayed when it is toggled. This informs a user thatthey can change from, for example, the generic name shown in window 244to the trade name or brand name by touching button 252 on the touchscreen.

From the patient browser window 244, a user is enabled to reviewmedications available for dispense to a patient. To review themedications that have been prescribed for a particular patient, a userhighlights the desired patient name by touching the name in the patientbrowser window 222 and touches a med order button 254. Touching medorder button 254 causes a med order browser window 256 shown in FIG. 31to be displayed. Med order browser window 256 includes information aboutthe medical items that have been prescribed for the patient includinginformation such as dosage and frequency of administration. The medorder browser window also contains other information such as the routeby which the medication is to be delivered to the patient such as orallyor through intramuscular injection. The med order browser window 256also includes the date and time information that the medication wasstarted. If a medication has been stopped, this may also be indicated.It should be understood that the use of any medical item for a patientmay be referred to herein as “giving” the medical item to the patientregardless of how the medical item is used in the course of a patient'streatment.

If a user wishes to take a medication for a patient, the user mayhighlight the medication on the med order browser window and touch adispense button 258. By touching the dispense button on the touchscreen, the display terminal is operative to cause the electronic lockdrawer, medication dispenser or other apparatus in which the particularmedication is held to operate to make the medication available to theuser. The med order browser window 256 further includes an info button260. Info button 260 may be pressed to display additional informationabout the particular medication which has been highlighted. This mayinclude particular information that the physician wished to includeconcerning the administration of the medication. Alternatively theinformation button may access information stored in the data store 85concerning the particular medication itself including information suchas possible side effects, drug interaction data and the like.

The med order browser window 256 further includes a trade name/brandname button 252 which may be used to change the displayed drugidentification information from generic to brand name and vice versa.Window 256 also includes a help button 240, a previous-page button 224and a next-page button 226, all of which function in the mannerpreviously described. The med order browser window 256 further includesa close button 238 which a user may select to return to the patientbrowser window 222.

Instead of reviewing medications that have been specifically prescribedfor a patient, a user from the patient browser window 222 may choose todispense medications and medical items from a listing of all medicalitems which are available in the area adjacent the display terminal. Toaccomplish this a user selects a supply button 262 on the patientbrowser window. Selecting the supply button 262 causes a supply browserwindow 264 to open on the screen of the display terminal. The supplybrowser window is shown in FIG. 32. Supply browser window 264 includes alisting of medical items which are available for dispense. A user mayselect one of these substances by touching the screen adjacent to theitem desired. If it is a controlled substance such as a narcotic, thedisplay terminal and associated computers are programmed to requireheightened security such as two authorized users to log on to thedisplay terminal before a dispense may be made as was previouslydiscussed.

A user dispenses medical items from the supply browser window 264 byhighlighting the item desired and selecting the appropriate selectquantity button 268. The select quantity button indicates how many ofone particular medical item the user desires to have dispensed. The userthen selects the dispensing button 258, which is operative to cause thedisplay terminal to actuate the appropriate device for dispensing therequested quantity of the item.

The supply browser window 264 also includes the trade name/brand nametoggle button 252 previously discussed. The operation of button 252 isdemonstrated with regard to an alternative supply browser screen 270which is shown in FIGS. 35 and 36. Alternative supply browser screenshows only one medical item so as to make more apparent the operation ofbutton 252. In FIG. 35 button 252 is set to display the generic name ofthe medical item, in which case the single medication shown is displayedby its generic name and button 252 indicates that it is available to betoggled to the trade name. Toggling button 252 changes browser screen270 to the format shown in FIG. 36 in which the trade or brand name ofthe medication is displayed, and button 252 indicates that it isavailable to be toggled to display the generic name. Of course, formedical items for which there is only a generic name, the data baserecords stored in the data store 85 in connection with computer 84 orother connected computer in the system may be arranged to indicate thatthere is no corresponding brand or generic name when this situationarises. Likewise for items which have multiple brand names, the displayterminal is preferably operative to provide all the brand namesassociated with the item.

The data store of the system also includes pricing information for bothbrand and generic medical items. The data terminal and connectedcomputers are operative to charge the patient's account for the type ofitem which is dispensed. This is determined responsive to the name forthe item displayed on the display terminal when the dispense is made.

In some situations the name type for an item prescribed for a patientmay not be available in the dispensers connected to the display terminalor otherwise available in the area adjacent the display terminal. Thedisplay terminal or connected computer may be programmed responsive to arequest to dispense an item by a trade or generic name which is notavailable, to indicate on the display terminal that the item isavailable under an alternative name. The user in response to receivingsuch an indication, may toggle button 252 and dispense the item underits alternative name. In such situations, the user may also considerthis a discrepancy which should be recorded in response to the userprompts generated in response to selecting the discrepancy button 250.The ability of the system to track items by both trade or brand namesand generic names may avoid needless delay in providing medical items.

The supply browser window 264 also includes a physician/route/sitebutton 272. Selecting button 272 causes a physician/route/site browserwindow 274 to be displayed. A sample physician/route/site browser windowis shown in FIG. 37. If there is already a physician associated with thedispense of the medication selected in window 264 to the particularpatient shown in that window, then a physician button 276 will behighlighted in window 274. If the physician button 276 is highlighted,then a user may press a route button 278 which will cause the displayterminal to display a further window which indicates the route that thephysician has prescribed for the medication to be administered to thepatient. A site button 280 may be selected to review the site on thepatient that the physician has prescribed for the medication to beadministered. If, however, when the user accesses window 274, thephysician, route or site buttons are not highlighted, no associationsrelated to these parameters have been made.

To associate a dispensing order with a physician, a user may select thephysician button 276 to display a list of physicians on the screen. Theuser may then select a physician which causes physician's name to behighlighted. The user may thereafter select the route button 278 whichcauses a listing of route information, as shown in FIG. 37, to bedisplayed. The user may then select a particular route by highlightingit. Thereafter, if appropriate, the user may select site button 280,which causes a list of sites to appear. The user may select a site. Tosave all the associated information that has been input, the userhighlights an accept button 282. After reviewing the information inwindow 274 or establishing a new relationship, a user may close window274 by selecting close button 238 and returning to patient browserwindow 222.

As previously discussed, a further advantage of a preferred embodimentof the present invention is that medical items to be used for aparticular medical procedure are stored in correlated relation alongwith a designation of the particular medical procedure in the datastore. These collections of medical items are called “kits” in thepreferred embodiment of the invention. Kits may be established by theoperator of the system in accordance with the particular needs of thesystem. Kits may include particular collections of medical items for aparticular procedure that is scheduled for a patient. Alternatively andin addition, kits may also be a collection of medical items used toconduct particular types of frequently-administered medical tests, suchas diagnostic tests.

In accordance with a preferred embodiment to the invention, from thepatient browser window 222 a user may review kit information byselecting a kit button 284. Selecting the kit button causes a kitbrowser window 286 shown in FIG. 33 to be displayed on the displayterminal. The kit browser window shows kits that have been prescribedfor the selected patient. In addition, the kit browser window preferablydisplays a listing of other available kits. A user may select aparticular kit by touching the kit on the touch screen. If the userwishes to learn what items are in the highlighted kit, they may select akit info button 287. Selecting the kit info button causes the displayterminal to display a kit information window 290 shown in FIG. 34. Kitinformation window 290 shows the name of the kit and all of the itemsthat are included in the kit. In addition the kit information windowshows how many of the particular items in the kit are available fordispense from the storage locations adjacent or attached to the displayterminal. The computer may alternatively be programmed either in the kitinformation window 290 or when a kit is dispensed, to indicate to a userwhere items that are not available in the area adjacent the displayterminal may be obtained. The inventory tracking features of theinvention enable providing the user with the nearest location the neededitem is stocked.

After reviewing the information concerning what is in the kit, the usermay select a close button 238 on kit information window 290 to return tothe kit supply browser window 286. The user may select the dispensebutton 258 in window 286. Selecting the dispense button is operative tocause the display terminal to dispense or make available all the itemsin the kit together. In addition, the display terminal and connectedcomputers may be programmed to indicate in response to selection of thedispense button that the user is required to manually take from openstorage certain medical items that may be required for the kit which arenot dispensed. This is accomplished through appropriate programming ofthe records in the data store when the kit is established. Of course,selecting the dispense button 258 not only causes all of the items inthe kit to be dispensed or otherwise made available, but such items arealso charged to the patient's account.

The storage of information in the data store concerning kits, which isdata representative of collections of items stored in correlatedrelation for a particular procedure or activity, is highly useful. Itprovides for automatically dispensing the needed items together wherepossible, and provides a visual reminder to the user of the system ofall the things that are needed to accomplish a particular medicalprocedure. This avoids mistakes and saves time. Of course, afterreviewing the kit browser window 246 and/or dispensing a kit, a user mayreturn to the patient browser window 222 by selecting the close button238.

After a user has completed dispensing transactions for a particularpatient, they may take medications for another patient by highlightingthat patient on the patient browser window 222 and repeating the stepsfor that patient in accordance with the procedures previously discussed.The system is programmed so that a user is free to obtain items eitherfrom dispensers of various types in response to dispensing requests, tomanually remove items from hook or box register locations or to takeitems from accessible storage locations. For those items which arecontrolled substances such as narcotics, dispensing transactions cannotbe completed until a second appropriate user or witness enters theiridentifying information to the system to witness the dispensingtransaction. As previously discussed, dispensing transactions which areconducted by a user or a witness are recorded by storing the informationon what was dispensed in correlated relation with the user's record aswell as with the patient's record in the data store. Of course, thesystem may be programmed to correlate and store other types ofinformation as well.

When a user is finished with dispensing medications for patients, theymay select the log-out button 232 at which point the display terminalwaits to be accessed by another authorized user.

It should be noted that the patient browser window 222 also includes arestock button 292 and a retrieve button 294. The restock button 292 isused in connection with restocking the system. Certain system users havecorrelated records in the data store that enable them to restock thesystem. Such a user, when they access the data terminal may also selectthe restock button 292 and cause the display terminal to display windowsupon which a user may indicate which items have been restocked, and theavailable quantities. The person restocking preferably does this byaccessing the dispensers and electronic lock drawers using keys oraccess methods which are not controlled through the display terminal.However, in other embodiments the display terminal may be used foropening the dispensers and electronic lock drawers for restockingpurposes as well. Once the user restocking the items has completed theinformation associated with the restocking activity, they can log out ofthe display terminal by selecting button 232.

Retrieve button 294 is likewise used by a selected group of authorizedusers. The retrieve button is used to enable certain selected users whohave authority to access medications that have been returned or wastedand which are stored in a particular retrieve drawer. Such an authorizeduser has an associated record in the data store that authorizes them todo this and when such a user authorizes the system and selects thisbutton, the retrieve drawers may be opened. To enable the user toretrieve such items, the process of retrieving returned or wastedmedications is described in copending allowed U.S. application Ser. No.08/679,203 filed Jul. 12, 1996, and allowed U.S. application Ser. No.09/015,162 filed Jan. 29, 1998, the disclosures of which areincorporated herein by reference. Again, after a user has conducted aretrieve activity, they may exit from the system by selecting thelog-out button 232.

Embodiments of the invention may also be used in connection with medicalitems which are “non-itemized”. Such items are generally not counted andnot tracked to patients so there is no record maintained in the datastore that such an item was taken for a particular patient. Likewise, inmost cases the item is not billed to the patient. However, in some casesitems may be tracked to a patient but not billed. Generally non-itemizeditems are stored in open storage locations. Any authorized person isfree to take these items for patients or for a medical condition thatthe user may be experiencing.

It is important however that supplies of non-itemized or otherwiseuncounted medical items be maintained at adequate levels. Because thesystem does not track the taking of such items it is possible for suchitems to fall below desired levels or to be completely depleted beforean appropriate person is notified to replenish the quantity of medicalitems in the non-itemized storage location. Significant time periods mayelapse before the supply is replenished.

An embodiment of the present invention operates to minimize the riskthat non-itemized medical items will be depleted. This embodimentenables a user, upon noticing that the level of items in storage in astorage location has fallen below a desired level, to indicate to thesystem this condition. An appropriate function within the medicalfacility is notified and the storage location is restocked. To achievethese results storage locations for non-itemized medical items arephysically marked to indicate a level at which restocking should beperformed. Generally this may be accomplished by placing a physicalmarking in the storage location, such as a line on a shelf. As items areremoved from the shelf for example from left to right, a user knows thatwhen the number of items remaining is “below the line” there is a needto indicate this quantity condition to the system. This level in someinstances may be referred to as a “minimum” acceptable level ofsupplies. Alternatively, the level may be referred to as a “par value”which means the average desirable quantity of medical items to haveavailable. Where the levels are set and how they are characterizeddepends on the medical item and the needs of the users of the system.

As shown in FIG. 38 a user approaching the display terminal is presentedwith the user log-in screen 302. In the embodiment of the inventionshown the user may press the “non-itemized button” 304 without logginginto the system. When the user presses the non-itemized button thenon-itemized inventory window 306 shown in FIG. 39 is presented on thescreen of the display terminal. Non-itemized inventory window 306presents a listing of the non-itemized inventory items as well as theirlocations.

The user, after accessing the non-itemized inventory window, mayhighlight a particular supply by touching the touch screen in the areawhere the item is listed. The user may indicate the particular quantitycondition that the user has noted for the supply. For example, if thesupply is below the desired level the user may touch the “below minimumbutton” 308 on the touch screen. Pressing this button causes a signal tobe generated and a message to be transmitted to the data store that theitems in this particular storage location are below the minimum. Thesystem is preferably programmed so that this information is alsopresented in the form of a message or report to the function ordepartment in the medical facility responsible for restocking thestorage location. In response a restocking of the particular storagelocation with the corresponding items is performed. Similarly if a usernotes that a particular supply position is out of stock, the user maypress the “out of stock button” 310 on the non-itemized inventory window306. Pressing the out of stock button causes a different signal to begenerated and transmitted to the data store, as well as to therestocking function. Preferably the system is programmed so that therestocking function is notified on a more urgent basis to replenish theitems in the storage location than in the case of a below minimumsituation. When the user is done using the non-itemized supply windowthey may return to the user log-in screen 302 by pressing the “closebutton” 312.

As shown in FIG. 39 the non-itemized inventory window 306 also includesa “trade/brand name button” 314 which may be used to change the suppliesfrom brand to generic name and vice versa responsive to pressing thebutton. Likewise, a “position/name button” 316 is provided so that thewindow 306 can present the non-itemized medical items either in order byname or by supply position. This facilitates finding a desired itemquickly.

The system of this embodiment is preferably operable to determine thelocations where supplies need to be replenished and to provide the userswho perform the restocking function with information on the types ofmedical items and the quantities which must be added to the storagelocations. In the case of non-itemized inventory a restocking user whohas replenished a storage location by adding a quantity of medical itemsthereto, may highlight the particular item and location and indicatethat it has been restocked by pressing a “restock button” 318. Often therestocking function will replenish all of the storage locations. Whenthis is done the restocking user may indicate that all the non-itemizedlocations have been restocked by pressing a “maximum all button” 320.The use of this feature saves considerable time for a restocker whowould otherwise be required to highlight the various items eitherindividually or in groups and change their status.

In an alternative embodiment to the invention, the actuation of therestocked button 318 and the maximum all button 320 may be limited tousers who are authorized to carry out a restocking function as indicatedby the data in the data store. In a system configured to be operated inthis manner, a restocking user would be required to log onto the systemusing the user log-in screen 302, as must be done for inventory that isitemized and tracked to patients. Once the user with restock privilegeshas logged in, the appropriate buttons may be touched to indicate thatthe quantity conditions at the storage locations have been changed.

The operation of the described embodiment of the system for handlingnon-itemized medical items provides a significant time savings forsystem users. Handling items as non-itemized is particularly appropriatefor common, low cost items which are often accessed and are not billedto patients. Implementing this approach avoids the need for users to gothrough additional and unneeded steps to take such items. Of course, ifthe institution operating the system decides that items in non-itemizedinventory should be tracked to patients, counted or billed, such itemsmay be reclassified in the data store. The result would be that suchitems would be removed from the non-itemized inventory listing andincluded in the listing in the supply browser window 264 and otherappropriate windows which show medications which are tracked and billed.

A further alternative embodiment of the system for tracking anddispensing medical items is shown in FIG. 40. This alternative systemgenerally indicated 322 is similar to the system described withreference to FIG. 13, except as otherwise indicated. The system 322includes a computer 324 which includes therein or is otherwiseoperatively connected to a data store, schematically indicated 326. Itshould be understood that computer 324 and data store 326 are shownschematically and that embodiments of the invention may consist ofseveral operatively connected computers and data stores.

The computer 324 is connected through a network 328 to other devices andsystems. Network 328 may be a local area network (LAN) within thefacility, or wide area network. Network 328, as in the previouslydescribed embodiment, is connected to the facility's admission,discharge and transfer (ADT) system schematically indicated 330.Likewise, network 328 is connected to the facility's information system(HIS) 332 and the facility's pharmacy system 334. Preferably, as in thepreviously described embodiment, all of these systems within thefacility are enabled to exchange information and function in cooperationwith other devices connected through the network 328.

System 322 also includes one or more administrator's workstations 336.The administrator's workstations are similar to those in the previouslydescribed embodiment of the system. The system also includes a pluralityof display terminals 338, only one of which is shown. Display terminal338 is similar to the display terminals 98, 76 and 102 previouslydescribed, except as otherwise indicated. Display terminal 338 includesa touch screen 340 which serves as an input device and an output device.The display terminal also has a fold down, alphanumeric keyboard 342which serves as an input device. Display terminal 338 also preferablyincludes a card reader, a processor, as well as its own local datastore, and interfaces connecting the display terminal to both thenetwork 328 and the other devices to which it is connected.

The display terminal 338 is in operative connection with storage devicesfor storing medical items. An electronic lock drawer 344 is connected tothe display terminal 338. Electronic lock drawer 344 is similar to theelectronic lock drawer previously described, except as otherwiseindicated. The electronic lock drawer includes a plurality of storagelocations for medical items and includes electrically actuated locks forselectively controlling access to the storage locations. The locks areopened in response to signals sent from the display terminal 338.

A refrigerator 527 is also connected to display terminal 338.Refrigerator 527 includes a lock module thereon and operates in a mannersimilar to the refrigerator 450 previously described. The refrigeratorhas an interior area which includes one or more storage locations forstoring medical items therein. A lock module on the refrigeratorselectively controls access to the interior area of the refrigerator inresponse to one or more signals sent from the display terminal 338.

A dispenser 346 is also connected to display terminal 338. Dispenser 346holds a plurality of different types of medical items in storagelocations therein, and selectively dispenses medical items from itsstorage location in response to signals from the display terminal 338.Dispenser 346 may be similar to dispenser 100 or preferably may be adispenser of the type shown in co-pending U.S. Application Ser. No.60/045,137 filed Apr. 30, 1997, the disclosure of which is incorporatedherein by reference.

The alternative system 322 further includes a reading device 348 inoperative connection with the display terminal 338. The reading device348 is preferably a device for reading machine readable indicia such asbar code. The reader device further preferably includes a display screenor other output device 350, as well as an input device 352 in the formof a keypad with alphanumeric designators and function buttons, throughwhich a user may enter inputs.

The preferred form of the reading device 348 includes its own internalprocessor and memory. The memory includes programmed instructionsreferred to herein as configuration data, which controls the operationof the processor and the components which make up the reading device.The configuration data includes data which enables the reading device torecognize and interpret machine readable indicia. It also preferablyincludes information on authorized users of the system and theircorresponding personal identification numbers (PIN). The configurationdata preferably further includes information on storage locations andthe location designators for locations associated with the displayterminal 338, as well as the medical items stored in those locations.The configuration data also preferably enables the reading device toreceive instructions and to generate transaction messages. Thetransaction messages are sent to the display terminal, and are thenforwarded to the other components of the system. The reading device 348also preferably includes a storage location or cradle schematicallyindicated 354. The cradle 354 provides a place for holding the readingdevice when it is not in use. In addition, placement of the readingdevice in the cradle may be used to initiate certain activities by thereading device as hereinafter explained.

This alternative form of the system of the invention is described inconnection with FIG. 40. Storage locations are preferably labeled withmachine readable indicia corresponding to the location designatorestablished in the data store for the particular storage location. Suchmachine readable indicia identifies the location and also preferably themedical item type to be stored in the location. As will be appreciatedfrom the description of the operation of the system which follows,including machine readable indicia representative of the medical itemtype enables the system to verify the data in its data store concerningthe type medical item stored in a storage location. This feature mayalso avoid the need for the data store to include information on themedical item types stored in certain storage locations, because suchinformation can be read directly. Alternatively, storage locations maybe labeled only with indicia representative of the location or themedical item, and the data stored in the data store can be used by aprocessor to resolve the corresponding medical item or location.

A schematic view of an open storage shelf indicated 356 is shown in FIG.40. Shelf 356 holds medical items thereon which may be removed by a userof the system. Shelf 356 includes machine readable indicia 358 thereonwhich identifies the particular storage location. The indicia may alsoinclude data representative of the medical item type stored therein.

Preferably the machine readable indicia also includes human readableindicia to advise a user what is stored in the storage location. This ispreferably done using a label, an example of which is indicated by label360 shown in FIG. 41. Label 360 is an example of a position only labelwhich includes machine readable indicia which indicates only the storagelocation and the medical item stored therein. Label 360 is an example ofthe type of machine readable indicia used on storage shelf 356 andindicated by machine readable indicia 358 thereon.

Further machine readable indicia are also applied to the storagelocations in this alternative embodiment of the invention. Such furtherindicia is explained with reference to storage shelf 362 shown in FIG.40. Storage shelf 362 includes machine readable indicia 364 which likeindicia 358, identifies the storage location. It should be noted thatindicia 364 is positioned so as to be accessible only when the medicalitems stored on shelf 362 have been reduced to a level such as the belowpar value or below minimum, where restocking is desirable. Of coursestorage shelf 362 may be marked in an appropriate manner as shown toindicate when the quantity of medical items stored thereon has fallen toa level where an input should be given to the system to replenish thelocation. Storage shelf 362 also includes further machine readableindicia 366. Further indicia 366 is preferably positioned to becomeaccessible when the last of the medical items stored on the shelf isremoved. In alternative embodiments further indicia 366 may be placed inother locations however.

FIG. 42 shows a label 368 which is used to indicate an out of stockcondition at a storage location. Label 368 corresponds to indicia 366shown in FIG. 40 on storage shelf 362. Label 366 indicates the storagelocation as well as the item stored therein, as well as the quantitycondition that the item is out of stock at that location.

As further shown in FIG. 40, storage shelf 362 includes further machinereadable indicia 370 thereon. Such machine readable indicia 370 ispreferably used by a user restocking the shelf 362 to provide an inputthat the particular medical item type stored in the location has beenrestocked. FIG. 43 shows an example of a label with indicia whichindicates that a particular storage location has been restocked with amedical item. Such labels are preferably positioned in locations whichare inconspicuous, and which can be read with the reading device 348when the storage location has been restocked.

It should be understood that storage shelves 356 and 362 are shown asshelves for storage of non-itemized inventory. Because non-itemizedinventory items are not tracked to patients, there is a need in someembodiments of the invention to distinguish such inventory from otheropen shelf type inventory that may need to be tracked. It is thereforepreferable to provide visually distinguishable characteristics forlabels or other machine readable indicia used for non-itemized inventoryto distinguish them from indicia used in connection with medical itemswhich must be tracked. One manner of accomplishing this is to usedifferent colored labels for itemized and non-itemized inventory.

For itemized inventory for which each unit is counted and/or tracked, itis desirable to provide separate machine readable indicia which can beused to indicate that a particular storage location is exhibiting aquantity condition corresponding to a level requiring replenishment, buthas not yet reached the level of being totally depleted. To accomplishthis for itemized medical items, machine readable indicia whichindicates the “below minimum” or “below par value” quantity conditionare placed adjacent to the storage locations. An example of such a labelused for accomplishing this function is indicated 374 in FIG. 44.

It should be understood that while the foregoing description discussesholding non-itemized inventory in open shelf locations, in otherembodiments of the invention non-itemized inventory may be held withinenclosures or other containers. Such areas may include cabinets withshelves for holding such items as well as environmentally controlledchambers including refrigerators, high temperature chambers, lowhumidity chambers and other types of containers where medical items maybe stored prior to use.

In the alternative form of the invention described with reference toFIG. 40, certain storage locations are controlled by an access controldevice such as the locks of an electronic lock drawer or refrigerator.Storage locations are also marked with machine readable indicia of thetype previously described. FIG. 45 shows an example of a single drawer376, within electronic lock drawer unit 344. Drawer 376 includes astorage location 378 for storing medical items therein. As shown in FIG.45, the storage location includes machine readable indicia in the formof a label 380, which indicates the location designator for the storagelocation as well as the medical item type stored therein. Storagelocation 378 further includes further machine readable indicia in theform of a label 382, which is an out of stock label. As shown in FIG.45, the out of stock label 382 is positioned on the bottom surface ofthe storage location, so that it becomes accessible when all the itemshave been removed.

It should be understood that for storage locations which hold medicalitems which are counted and/or tracked by unit, the computer maycalculate, and the data store may include, data representative of thenumber of units remaining in each storage location. However, it is alsopossible to include among or on the units of medical items machinereadable indicia, which can be used to indicate that the number ofmedical items in the storage location has fallen to a level whererestocking is required. Such indicia may be on the item which the usercan scan when the item is taken. Alternatively, the indicia may be on acard or other divider placed between the medical items. In either casewhen the indicia is scanned the system is apprised of the number ofunits remaining at the location.

In the alternative form of the invention not only are each of thestorage locations marked with machine readable indicia, but the accesscontrol devices themselves, such as the electronic lock drawer orrefrigerator, are marked with unique indicia. In the case of electroniclock drawer 344 this may include labeling the entire electronic lockdrawer unit with a single machine readable indicia. Alternatively, itmay include labeling each drawer (or storage location within a drawer orother interior area) in the electronic drawer unit with such indicia.This indicia may be used in a manner later explained to selectively openthe electronic lock drawer unit. Of course a similar approach may betaken with refrigerator or other devices which house medical items.

The alternative form in the system 322 shown in FIG. 40 includes areport generating means which is schematically indicated by a printer384. Printer 384 may be positioned at a nursing station, restockingstaging station or other location that is convenient for users of thesystem. It should be understood that while only one printer is shown,additional printers or other types of report generating means may beincluded in the system. The printer 384 is in operative connection witha computer 386. Computer 386 operates in accordance with programmedinstructions and includes an internal memory or data store therein.Computer 386 is in operative connection with the network 328.

The printer 384 is operative responsive to the programmed instructionsstored in connection with the computer 386 to generate reportsschematically indicated 388. The reports produced by the reportgenerating means preferably include both human readable indicia as wellas machine readable indicia. As later discussed in detail, reports whichinclude such indicia may be produced for use in dispensing medicationsas well as for restocking the storage locations of the system.

In the alternative form of the invention, storage locations may belabeled with other types of machine readable indicia. Such indicia arerecognized by the reader in accordance with its configuration. Incertain embodiments “prefix” labels or similar indicia may be applied.Such prefix labels indicate a particular quantity condition. The prefixlabels indicate the quantity condition exists at the locationcorresponding to the next location indicia read. In the preferred formof the invention the quantity condition associated with the prefix labeltakes precedence over any quantity condition associated with the nextlabel that is read, provided the next label is read within a set timewhich is established in the reader configuration.

For example, a single prefix label indicating a “restocked” quantitycondition may be placed adjacent to several storage locations. Arestocking user may indicate that he or she is filling an empty storagelocation by reading the “restocked” prefix label, and then reading the“out of stock” label or “below par” label at the location within the settime. Because the prefix takes precedence over other quantityconditions, the other quantity condition in the label is disregarded andthe reader stores data which indicates that the particular storagelocation has been restocked.

Other types of prefix labels indicating other types of quantityconditions may be placed adjacent to storage locations and used in asimilar manner. Such other prefix labels may be associated with quantityconditions such as “below par”, “out”, “out of stock, emergencyrestocking needed”, “one unit taken” or other quantity conditions.Reading a prefix label indicates the quantity condition for the nextlabel read which includes a location identifier (provided it is readwithin the set time) regardless if there is a different quantitycondition indicated on the label that includes the locationidentification data.

In the alternative form of the system the configuration of the readerdetermines a quantity condition being indicated based on a hierarchy. Aquantity condition indicated by a prefix label is at the top of thishierarchy. Thus, prefix label data when read takes precedence over anyother quantity condition that may be included in indicia subsequentlyread by the reading device or established through the configuration ofthe reading device.

The second tier in this hierarchy is preferably the “out” quantitycondition. Thus, if a different quantity condition is established by theconfiguration of the reader, and a label indicating an “out” conditionat a storage location is read, the reader configuration will interpretthis as an “out” indication at that location. However, if a prefix labelhad been read first, the =quantity condition associated with the prefixlabel would be indicated because prefix labels are higher in thehierarchy.

As later explained, the reader includes data representative ofauthorized users. The data representative of certain authorized usershas stored in correlated relation therewith a quantity condition thatthe user normally reports or performs. For example, if a user normallytakes medications for patients, the quantity condition associated withthat user data would be “one taken”. As a result, when that user is“signed on” the reader, and reads a label which includes locationindicia, the configuration of the reader will interpret the reading ofthe location indicia as indicating the “one taken” quantity condition atthat location. This would be true unless a “prefix” or “out” label hadbeen scanned.

As later discussed, users may have various quantity conditionsassociated with them. In addition to “one taken” for users who normallytake items, restocking users may have the “restocked” quantity conditionassociated with their identifying data. Other types of quantityconditions can be assigned to particular users who normally perform theact or function associated with their associated quantity condition.

The configuration of the reader preferably provides a time period for auser who has identified himself or herself as operating the readingdevice, to begin reading location indicia where the quantity conditionassociated with the user has occurred. If the reader “times out” withoutlocation data being read, the next read location will not be treated ashaving the quantity condition associated with the particular user.

The lowest level in the hierarchy is one where no user with anassociated quantity condition has indicated that he or she is operatingthe reader, and no “out” or “prefix” label has been read. At this lowestor default level, the configuration of the reader interprets the readingof indicia which includes a quantity condition and location as thecondition existing at the location. If the indicia does not include aquantity condition, and only location data is read, the configuration ofthe reader interprets that as a “below par” quantity condition at theparticular location. This is done provided the location is one where themedical items are not counted as indicated by the system configuration.If the location indicia read is of an improper type such as in adispenser where “below par” is not appropriate, the configuration causesan “error” signal indication to be given. Such error indications arealso given when any operation of the reading device is attempted whichis incompatible with the configuration of the reader.

In operation of the alternative system shown in FIG. 40, the readingdevice 348 is operated by users of the system to accomplish dispensingand restocking activities. In a first form of this alternativeembodiment the reading device is operated to perform activitiescomparable to those previously described as accomplished using thedisplay terminal. The reading device includes the screen 350 whichserves as an output device, as well as input devices 352, which enableit to be operated in a manner similar to the display terminal 338. Aspreviously discussed, the reading device 348 includes a processor and amemory which enables it to operate independently of the processor andmemory of the display terminal. In this form of the invention thereading device is a bar code scanner, Model PDT 3100 made by SymbolTechnologies. Of course in other embodiments, other reading devices suchas personal digital assistants, portable or hand held terminals orsimilar devices may be used.

The reading device may be connected to the system by a data line asshown. Alternatively, the reading device may connect to the system bywireless communication methods, such as IR or RF. Other wirelessconnection methods such as inductive or capacitance coupling approachesmay alternatively be used, as well as periodic electrical coupling orother physical connection techniques.

In a first mode of operation, the reading device operates in accordancewith the logic flow shown in FIGS. 47-49. As previously discussed, allauthorized users of the system are preferably provided with badges,identification cards, identifying articles or have distinguishingfeatures which include machine readable indicia identifying them asauthorized users of the system. The memory in the reading device 348 isconfigured to hold information concerning the indicia associated withauthorized users. It is also preferably configured to store and holdeach user's personal identification number (PIN) uniquely associatedwith the user. The reading device also holds the particular quantitycondition function data, such as dispensing or restocking, which certainusers are associated with. All of this information is established in thedata store 326 in the course of setting up the system and in theexemplary embodiment is down loaded into the configuration of thereading device 348 through an interface which resides in the displayterminal 338. The reading device 348 is configured so that it defaultsto providing a “below minimum” quantity condition message in the eventthat no other quantity condition is specified. The reading device 348 isalso configured to produce transaction messages as well as othermessages which are sent to other components of the system. These includemessages which update the information stored in the data store 326.

The logic flow for the reading device begins as represented in FIG. 47.A user wishing to operate the system through the reading device 348begins with the processor executing a process 390 in response to a userscanning a machine readable indicia, which for purposes of this examplewill be a bar code. The bar code scanned may be indicative of aparticular supply storage location. If such location indicia is scannedwithout first scanning indicia which identifies a user, the hierarchy inthe configuration of the reading device previously described interpretsthe activity as indicating that the medical items stored in the positionscanned are “below minimum”. In response, the reading device 348generates a transaction message which indicates that the medical itemsin the storage location have this quantity condition.

Alternatively, a user may find that a particular storage location is outof stock. In response to observing this quantity condition, the user mayscan the bar code label similar to that shown in FIG. 42. In response toscanning such a bar code process 390 causes a transaction message to begenerated which indicates the out of stock quantity condition at theparticular storage location. In accordance with the hierarchy in theconfiguration data, the “out” quantity condition is indicated when thislabel is scanned, regardless of whether the user is logged on andwhether the user is associated in the data store with a particularquantity condition.

Alternatively a user may indicate a below minimum or out of stockcondition by scanning the out of stock bar code at a storage locationwhich will cause similar transaction messages to be generated. Storagelocations may be provided with “below minimum” labels similar to thoseshown in FIG. 44 so that a user may indicate the below minimum quantitycondition by scanning this label, without having to log on the system.Alternatively, if a user who normally takes medications is logged on thesystem, a “below minimum” condition at a location can be indicated byscanning a “below minimum” prefix label and then any label whichincludes the location indicia for the location where the below minimumquantity condition exists.

Enabling a user to scan the bar code labels which are representative ofthe below minimum and out of stock quantity conditions is a time savingfeature. This is particularly true when the user is indicating suchconditions for non-itemized inventory. In such circumstances the user isnot required to log into the system, but nevertheless can indicate theseconditions so that persons with the responsibility for restocking thestorage locations may be notified.

As indicated in process 390, if a user wishes to log onto the systemusing the reading device they may first scan the bar code or othermachine readable indicia on their badge, identification card, etc.,using the reading device. In response to the user scanning a properbadge, identification card, or other item, the processor in the readingdevice proceeds to the next process in the logic flow, process 392. Ofcourse as indicated in process 390, if any bar code other than anappropriate bar code is scanned, an error signal is generated, an errorindication is presented on the screen and the reading device returns toprocess 390 in the logic flow to wait for further input.

In process 392 a user is prompted through the screen 350 on the readingdevice to input their PIN. A user can do this through the keypad whichis part of the input device 352. The configuration of the readerprovides a predetermined time after scanning the badge or identificationcard for a user to input their PIN. If this input is not accomplishedwithin the set time, the logic flow returns to process 390. Similarly auser may return to process 390 by pressing a “cancel” key on the inputdevice 352 or by sending a log out message. In the preferred form of theinvention the log out message is generated by scanning a particular barcode which is conveniently placed for this purpose. In addition, or inthe alternative, the reading device may be programmed to generate a logout message when it is returned to its cradle 354.

If a user proceeds to enter a PIN number within the time periodprovided, the reading device 348 checks the PIN against the data storedin its memory. If the PIN is verified as correct the configurationchanges the operation of the reading device so that the subsequentscanning of position bar codes is taken to represent the particularquantity condition function which is associated with the user. As aresult, if the stored configuration data indicates that the usernormally dispenses medications, the subsequent scanning of a positionbar code will be interpreted as a dispense of that medical item (a “onetaken” quantity condition). Likewise, if the stored data indicates thata user is normally involved with restocking activities, the subsequentscanning of a location bar code will be taken as a restocking event. Ofcourse other types of quantity condition functions (or a no quantitycondition function) may be associated with particular users.

In the alternative form of the invention the report generating device,which is printer 384, generates reports. The report generating devicepreferably produces reports which include the names of patients who mayreceive medical items as well as indicia, such as bar code, whichcorresponds to each patient. In the preferred form of the invention, thereports further include the medical items that have been prescribed forthe patients as well as machine readable indicia representative thereof.This information is based on the information stored in the data store.Preferably the reports are limited to patients in the rooms which havebeen designated through the programming of the system as associated withthe particular display terminal to which the reading device 348 isattached. In this embodiment a computer program called “The Bar Tender”commercially available from Seagull Scientific Systems is used forgenerating bar code indicia. Of course, in other embodiments otherprograms may be used for producing the text and indicia which comprisereports.

In the alternative form of the invention, a patient may be selectedusing the reading device 348 by scanning the bar code associated withthe particular patient printed on the report. The user is preferablyprompted to do this as the configuration logic executes process 394, asshown in FIG. 47. If the user scans a patient bar code, a timer builtinto the configuration of the reading device waits a time for the userto scan a position bar code. The user may accomplish this by scanningthe position only bar code similar to the one shown in FIG. 41, if themedical item to be taken is stored in an open storage location. If sucha bar code is scanned a transaction message will be generated that suchitem was taken by the user for the indicated patient. The user mayindicate that several of the same items were taken by scanning the barcode a number of times corresponding to what was taken. Similarly, theuser may scan several different locations to indicate the differentitems taken for the patient.

If the medical items which are needed for the patient as indicated inthe report 388 include items positioned in an electronic lock drawer344, the user may scan the bar code on the electronic lock drawer. Ifthe data stored in the data store 326 concerning the user indicates thatthey have authority to access the electronic lock drawer, suchinformation will be included in the configuration data for the readingdevice. As a result, when the user scans the bar code associated withthe electronic lock drawer, the access control system which controlsopening the drawers, will open and make the medical items thereinaccessible. The user may then open the drawers where the medications areneeded and may indicate the taking of medical items for the patient byscanning the position labels for the storage locations holding themedications, such as label 380 shown in FIG. 45. This generates atransaction message indicating that the medical items stored in thestorage locations for which the labels have been scanned have been takenfor the designated patient.

In alternative forms of the invention, each of the drawers in anelectronic lock drawer unit may be labeled with machine readable indiciawhich enables the access control device to provide access to each drawerindividually. Likewise, the reading device 348 may be configured toprovide access for users to the drawers selectively. This may bedesirable when drawers of the electronic lock drawer unit 344 containmedical items which are only to be accessed by certain personnel, orwhich require two authorized users to log-in in order to access themedical items in a particular drawer. As will be appreciated from theprevious discussion concerning the display terminal, the reading device348 may be configured to require two authorized users to log in toachieve the dispense of a selected medical item such as narcotics, in amanner comparable to that done using the display terminal.

It should be appreciated that while the process of using the readingdevice in connection with electronic drawer devices has been described,similar processes may be used in connection with other devices whichhold medical items. These include refrigerators such as refrigerator527, cabinets and various other types of units which include storagelocations for medical items.

After a user has scanned the bar code at the storage locations fromwhich medical items have been taken for the indicated patient, the usermay log off the system as indicated in process 394 which returns theprocessor to process 390. Alternatively, the user may scan the indiciacorresponding to another patient and may scan the storage locations forthe medical items taken for that patient in the manner previouslydescribed. The user may take medical items for a number of patientsbefore logging off the system. The configuration within the scannercauses transaction messages to be generated which include informationabout the dispense events. Such transaction messages preferably includedata representative of the patient, the medical item and its storagelocation, the user of the system taking the item, as well as the timeand date information that the item was taken. Of course the transactionmessages also include data representative of the quantity conditionwhich the transaction message represents. In the case of a dispensequantity condition, the transaction message includes a quantitycondition indication which includes data representative of a dispense.This indication distinguishes it from transaction messages whichindicate other quantity conditions such as below minimum, out of stockor restocked. The processor and the configuration in memory in thereading device serve as a quantity condition indicating device whichoperates to generate the quantity condition indication which is includedin the transaction messages.

As shown with reference to the logic flow associated with process 394,if an improper scanning operation is performed, the logic returns thesystem to an appropriate process. The configuration of the readingdevice is also set up to provide the user with appropriate textualprompts. For example, the configuration of the reading device causes thesystem to consider the next transaction to be a dispense due to datastored for a user who has logged on the system. However, rather thanindicia associated with a patient being scanned next, a bar codeassociated with a storage location is scanned. In this case the logic inprocess 396 is executed by the processor in the reading device. Process396 directs the logic flow to the appropriate process based on asequence of inputs made. Further as shown with regard to process 394, auser operating the reading device is free at any time to scan the barcodes to indicate a below minimum or an out of stock quantity conditionat a storage location, which causes a transaction message to begenerated corresponding to the condition which is read.

Alternative embodiments of the invention may operate dispensing devices,such as dispenser 346, or enable access to storage locations which arecontrolled by access control devices, such as lock drawer unit 344, orrefrigerator 527, in response to indicia which corresponds to themedical items prescribed for patients printed on the reports. Thereading device 348 is preferably configured to include datarepresentative of the storage locations within the dispenser and otherdevices. A user wishing to dispense a medication from a dispenser,rather than scanning a storage location or an electronic lock drawerunit, may scan the indicia corresponding to the medication desired fromthe report. In response, the reading device causes the medical item tobe dispensed from its storage location in the dispenser, if that iswhere the item is found. Similarly, if the medical item corresponding tothe scanned indicia is stored in the electronic lock drawer or theinterior area of the refrigerator, the access control device will enablethe drawer or refrigerator holding the item to be accessed by the user.

The ability to dispense and access medications based on the machinereadable indicia from the reports further increases the speed at whichitems may be dispensed and the information recorded for eventual storagein the appropriate data store of the system. Further, in thisalternative form of dispensing medications, a confirmatory step may berequired by the configuration of the reading device so as to provide anindication that the requested item was in fact dispensed or taken. Thismay include for example the user providing an input through the keypad,which is part of the input device 352 of the reading device, oralternatively scanning machine readable indicia on the dispenser, or ontheir identification card or badge. Such functionality may be readilyincluded with the logic which is part of process 394.

The various signals which have been scanned or otherwise input into thereading device 348 are used to generate the transaction messages. Thismay be done as data is being read or is preferably done after the userlogs off the reading device. The transaction messages are standardizedwithin the system and are generated in accordance with the configurationdata stored in the reading device. The transaction messages arepreferably dispatched in a batch mode after the user logs off to avoidslowing the user down waiting for messages to be transmitted to otherparts of the system. When the user logs off the transaction messages aresent through the interface in the display terminal 338 and into thenetwork 328 from which they are received by computer 324 or othercomputers connected to the system. The transaction messages are used toinclude information about the quantity conditions and other events whichhave been carried out, in the data store 326. Of course it should beunderstood that the transaction messages may be sent to a number ofdifferent computers and modify data in numerous data stores depending onthe programming of the particular system.

In this embodiment of the invention, after the transaction messages havebeen sent by the reading device 348 to other parts of the system, thecomputer 324 is operative to down load current configuration data intothe reading device. This assures that the most current information isconfigured in the reading device.

In the operation of the alternative version of the invention, thetransaction messages received by computer 324 may be indicative of aneed to replenish the supplies of medical items at certain storagelocations. This is true regardless of whether the transaction messagesare generated based on inputs to the reading device or to the displayterminal. In response to such conditions being indicated, computer 324in cooperation with computer 386 or other similar computers positionedelsewhere in the system and connected through the network 328, isoperative to cause a report generating device such as printer 384 toprint a report concerning the storage locations needing to be restocked.Preferably the report includes information concerning the storagelocations requiring restocking, the medical items stored therein, andthe quantities of such medical items that are needed. The reportpreferably includes this information both in human readable and inmachine readable form.

A person who is to restock the storage locations for which the report isprinted may use the reading device 348 to facilitate the input to thesystem of restocking information. The restocking function is furtherdemonstrated with reference to the logic flow processes shown in FIG.48. A restocking user who logs into the system does so in the mannerpreviously described with regard to a user who conducts dispensingactivities. However, such a restocking user will have data stored in theconfiguration of the reading device which indicates that they perform arestocking function. From the process 394, with a restocking user loggedon, the user preferably scans the bar code corresponding to a particularstorage location to be restocked. An example of restock order bar codefound in a restock report is indicated 398 in FIG. 46.

Upon scanning the restock order bar code on the restock report, thelogic executed by the processor in the reading device next moves toprocess 400. In process 400 the user scans the bar code for the storagelocation being restocked. This may be the bar code corresponding to anopen storage location, a location in an electronic lock drawer, alocation in the interior area of a refrigerator or a location in theinterior of a dispenser. The reading device 348 is preferably configuredto prompt the restocking user to scan the position only bar code. Afterthe position bar code has been scanned the logic next moves to process402 in which a user enters the quantity of medical items currentlystored in the position. This is done by the user counting the items andusing the numeric keys in the input device 352 of the reading device.The user is preferably prompted to do this on the screen 350 by theconfiguration of the reading device. The requirement to input existingquantities is only carried out for medical items which are itemized andcounted. For non-itemized items where absolute quantities are not aconcern, the reading device is preferably configured to enable a user toavoid the input of current position quantities.

The current position quantity information is useful for counted anditemized inventory items as it can be compared to information stored inthe data store 326 to verify that dispense events have been properlyrecorded. If a discrepancy has occurred, the computer 324 is preferablyprogrammed to provide an indication thereof at the administrator'sworkstation 336 or at another appropriate output device in the system.

After a user has input the current position quantity at process 402, thelogic next moves to process 404 in which the user enters the quantitywhich is being restocked in the storage location. The user is preferablyprompted to do this by prompts presented on the display 350. Of courseas indicated in processes 400, 402 and 404, if a user makes an error inthe sequence of scanning or inputting, indicates that they wish tocancel the transaction, or the timers included in the configuration timeout without receiving the next required input, the logic returns to anappropriate process.

It should also be noted in FIG. 48 that a restocking user is alsoenabled to restock without using the restock order bar code on arestocking report. As indicated in the logic flow a user who has restockrights is enabled to move from process 394 to process 402 by scanningthe position on the storage location to be restocked.

Of course restocking operations cause the reading device to generatesignals which are indicative of the quantity condition associated with aposition being restocked. The reading device is operative based on itsconfiguration to build transaction messages corresponding to therestocking activities at the various storage locations. Thesetransaction messages include data representative of the user performingthe restocking activity, the storage location, the medical iteminvolved, as well as the time and date of the activity. Again thesetransaction messages may not be transmitted to the other components ofthe system until after the user logs off the system. This assures thatthe restocking user may perform their operations at the fastest possiblerate.

FIG. 49 shows the logic flow associated with the generation oftransaction messages which indicate that the number of medical itemsstored in a storage location is below minimum or out of stock. Generallysuch transaction messages will be generated by scanning a position barcode when the reading device is in the “default” mode due to no userbeing logged on. Alternatively, a prefix bar code indicia representativeof a “below minimum” with location indicia, or an “out of stock” indiciaat a location may be scanned at any time. This is represented by logicprocess 406 which is indicated as the calling state in FIG. 49. Itshould be understood that the calling state may be either process 394 orprocess 390 as indicated by process 406. As shown in FIG. 49 from thecalling state 406, provision is made when a restock order bar code isscanned from a report, to move to logic process 408 in which a userscans the bar code for the position being restocked. This enables arestocking user to indicate that the position is being restocked. Alsofrom the calling state, a user can scan a prefix bar code which mayinclude quantity conditions such as below minimum, out of stock, orrestocked, and then a bar code including a position or location. Thiscauses the logic to move to process 410 which produces transactionrecords accordingly.

The logic flow process described in FIG. 49 provides system flexibility.This logic enables the user to scan sequentially a prefix label, andthen a position label so as to selectively indicate a particularquantity condition for a storage location. This may be advantageous,such as for example, when a restocking user is scanning machine readableindicia from a report and from storage locations. Of course manyarrangements of machine readable indicia both on reports and storagelocations, as well as logic flow processes are possible depending on theneeds of the system operator.

The alternative system 322 shown in FIG. 40 may be programmed to havethe reading device 348 configured to operate in conjunction with thedisplay terminal 338, rather than as a completely separate userinterface device. In some alternative embodiments it may be desirablefor users to select patients using the screen 340 of the displayterminal in the manner previously described when dispensing is conductedusing the touch screen interface of the display terminal. Thereafter,the user may indicate taking of medical items from storage locations byscanning the machine readable indicia associated with those storagelocations with the reading device. Likewise dispensers, electronic lockdrawers, refrigerators or other storage locations, access to which iscontrolled by an access control device, may be operated so as to rendermedical items therein accessible in response to scanning of indiciaassociated therewith by the reading device. The taking of such items forthe patient selected at the display terminal may be recorded in the datastore upon such medical items being rendered accessible by the accesscontrol device, or may require further input to confirm the taking ofthe item either by scanning or by an input to the display terminal. Thesequences and processes may be varied to suit the level of securitydesired for the particular medical items involved.

It should be understood that while the report generating means of thedescribed alternative embodiment is a printer which enables the printingof bar codes, other embodiments may include other types of devices whichmay produce machine readable indicia. These may includes devices whichinclude hard copy or other types of displays or signals, which arecapable of being read by a machine. Alternatively, in certainembodiments the reading device may be programmed to read human readabletext provided on a report or other output device. In alternativeembodiments audio, magnetic or other indicia may be substituted for theoptical type machine readable indicia that have been previouslydescribed.

A further novel aspect of the alternative embodiment of the invention isassociated with its capability of operating to perform dispensing andrestocking activities despite other components of the system becominginoperable. Specifically the reading device 348 may continue to operateto record dispense and restock transactions despite a malfunction of thedisplay terminal 338, network 328 or any of the other connectedcomputers or systems. As previously discussed, the reading device 348generates transaction messages in response to the signals generatedtherein. The reading device is preferably configured so that if thebatch transactions cannot be successfully transmitted to other parts ofthe system, such transactions will continue to be held in memory in thereading device. It may be desirable to continue to have the readingdevice hold a record of the transactions for a period of time, eventhough they have been successfully transmitted to other components ofthe system. This enables recovery of the data should it later be lostfrom the data store 326 or other connected system components.

The capability of the reading device 348 to store and later forward suchtransactions creates a possibility that quantity condition informationmay reach the data store 328 after later, more current information hasbeen stored therein. It would be undesirable to modify more currentinformation with previously generated data which may no longer beaccurate.

To overcome this problem the transaction messages, as previouslydiscussed, include a time of each transaction. The time preferablyincludes both time and date. The data store 326 likewise includes datarepresentative of a time (and date) the data which is used to update thedata store was generated. Upon receiving data from a reading device (orpreferably any device such as a data terminal or other system componentwhich has the capability of operating independently) the computerconnected to the data store is operative to compare the time informationassociated with the transaction data it is receiving with thetransaction time of the most recent data that it has already received.If the time associated with the transaction message it is receiving ismore recent than the update to the data it has most recently received,the data in the data store is updated accordingly as is the transactiontime information associated with the update.

On the other hand, if the message being received by the data store isassociated with a transaction which occurred at a time which precedes amore recent update to the same data, the computer 324 will not supersedethe more recent data. Rather the computer is programmed to store thetransaction message data and use it for further processing. In certaincases the message will be sent to the administrator's workstation sothat a system operator may review whether the data which the system hasmaintained needs to be modified.

An example of a situation where the computer 324 may have received morerecent data before older data is received is when persons restocking thesystem use other types of input devices to indicate restocking data. Thereading device 348 may generate a transaction message which indicatesthat a particular storage location is out of stock. However, due to theperiodic transmission of the data from the reader, or other operationalfactors, the data store may not have received the transaction data for atime after the user reads the indicia from the location. A restockerusing a separate message connection path into the network, such as aportable terminal, may have restocked the position subsequent to the outof stock indication being read. The restocker's data may have beenreceived at the data store. Without the provision that is made in thisembodiment for checking the time information in the transactionmessages, a subsequent receipt by the data store of the message that hasbeen in storage in the reading device would wrongly cause the data storeto indicate that the storage location was out of stock. Because thesystem includes the feature for selectively updating the data based onthe time associated with the transaction message, the risk of suchproblems is minimized.

The ability of the system to selectively update the data store based onthe time that message data originated enables the operation ofalternative embodiments of the invention in which dispensers, lockdrawers, refrigerator lock modules and other devices need not be incontinuous communication with the other components of the systems.

In such an alternative embodiment electronic lock drawers, refrigeratorlock modules, dispensers and other medical item storage devices whichselectively control access to medical items, similar to those previouslydescribed, are used. However in this alternative embodiment such devicesinclude or are in operative connection with a local processor and amemory. The local processor is connected to a local message input deviceand a local message output device of conventional types which enable theprocessor to send and receive messages. In one form of this embodimentthe local input and output devices include IR receivers and emittersrespectively, but other types of wireless or other connections mayalternatively be used.

In this alternative embodiment the reading device used has operatingcharacteristics similar to reading device 348 except that the readingdevice preferably includes a wireless interface that is capable ofcommunicating with the display terminal or the network, as well as withthe local message input device on the dispensing devices.

The local memory on the dispensing devices is preferably configured tohold data representative of authorized users, as well as medicationsstored in the various storage locations in the dispenser. The localmemory is also configured to cause the processor to operate to makemedical items available in response to an appropriate message receivedat the local message input device. The local memory is furtherconfigured to generate transaction messages which include data similarto transaction messages generated by the reading device. Theconfiguration of the local memory in the dispensing device is preferablyestablished by downloading data into the local memory through the localmessage input device. This may be done using an IR communicationsinterface in the network which communicates with the dispensers, or byusing a portable terminal device to provide the configuration data.

In operation of this alternative embodiment, a user logs on the readingdevice in a manner similar to that described in the previous embodiment.The reading device operates in a stand alone manner based on itsconfiguration data.

A user operates the reading device by scanning patient and medicationdata from reports or otherwise in the manner previously described.However, unlike the other embodiment where the reading device transmitsits signal to the data terminal and the data terminal transmits amessage on a data line to a dispenser, in this embodiment the readingdevice sends its output directly to the local message input device by IRcoupling. The message from the reading device preferably includes datarepresentative of the authorized user who is operating the readingdevice. The processor in the dispensing device preferably checks theuser identity data against the configuration data related to authorizedusers in its memory. If the user is indicated as authorized, thedispenser makes the medical item indicated by the message available tothe user. The reader also preferably provides as part of the message tothe dispenser, data representative of the patient (if appropriate) andother data that is included in the transaction message eventuallygenerated by the reading device. This information is also stored in thememory of the dispensing device. Of course, the processor in thedispenser may provide the time data and other data directly or from itslocal memory.

The dispenser through its local output device preferably provides datato the reading device representative of the storage location from whichthe medical item was provided. The reading device holds this data andincorporates it into its transaction message data.

The reading device is eventually again placed in communication with thenetwork 328. This may be done by returning it to its cradle in which itis coupled by IR or in another manner to the network. The transactionmessages produced by the reading device are used to update the storeddata concerning the patients and the medical items in storage locationsas in the previous embodiments.

Periodically data from the memory of the dispenser is delivered to theremainder of the system and used to verify the transaction messages fromthe reading device. This can be done through the local message outputdevice being coupled to a receiving device connected directly to thenetwork 328, or by use of a portable terminal which receives and storesthe data. The portable terminal is eventually connected to the network.The computer comparable to computer 324 in this embodiment is programmedto compare transactions from the dispensers to those already receivedand to disregard duplicates of transaction already received. Anydiscrepancies may be directed to the appropriate function in thehospital or other facility in which the system is operated.

The reading device may also be used during restocking of storagelocations in the dispensers in the manner previously described. Thereading device provides messages which are used to update the storeddata. The data from the memory of the dispenser may be used to verifythe reading device data and to identify discrepancies.

As will be appreciated, this alternative embodiment has the advantagesthat the dispensers and storage locations are totally “stand alone”units. This offers greater flexibility in their placement and reducescost of installation of the system. The alternative form of the systemfurther provides the advantage that if the reading device is lost ordamaged, records of any activity conducted since the reading device lastsent messages to the network can be recovered from the dispensermemories. The dispenser memories may be configured to hold data for suchtime after providing the data back to the network to assure datarecovery.

It should further be understood that in this alternative embodiment morethan one dispenser or similar device may share the same local processor,memory and input and output devices. Further, open storage locations mayhave a local processor, memory and connected input and output devicesadjacent thereto to store a record of the transactions conducted withthe reading device at the open storage location. Of course suchprocessors and memories would not need to be configured to perform anydispensing control activities which would simplify installation andoperation. Other arrangements and alternative systems will be apparentto those skilled in the art from the foregoing description.

The restocking of the various storage locations within the systems ofthe previously described embodiments may be facilitated using a methodwhich includes the positioning of removable liners within the storagelocations. In the execution of this method the liners are stocked withmedical items at a remote stocking location such as in a pharmacy withina medical facility or at an offsite packing location. The liners arepreferably secured and labeled with indicia which indicate the locationswhere they are to be installed. This location identifying indicia may invarious embodiments of the invention include specific location data,indicia representative of the particular type of medical items stored inthe liner, or a combination of both.

The liners that have been loaded with the medical items are transportedto the storage locations. The storage locations are then accessed by arestocking user in the manner established for the system. The previouslyinstalled liners are removed and the filled liners are then installed.The devices securing the new liners in the closed positions are openedeither before or after installation of the new liners in the appropriatestorage location. As later discussed, steps may be taken to assure thatthe liners are properly installed. Medical items from a previouslyinstalled liner may be transferred to the newly installed liner and arecord thereof made. Alternatively the previously installed liners maybe secured with the remaining medical items stored therein.

The new liners are installed to replace the previously installed linersin a plurality of different storage locations and dispenser devices, aswell as in open or other types of storage locations. The previouslyinstalled liners are returned to the stocking location for an accountingof the medical items which may be still held therein, and for reuse.

A schematic view showing the steps of the restocking method isschematically represented in 55. FIG. 55 shows a system 530. System 530may be similar to system 322 or other systems previously described. Itshould be understood that additional hardware and software features maybe included in or connected to system 530, and that only certainfeatures and components are shown to facilitate understanding of themethod.

System 530 includes one or more operatively connected processors anddata stores. This is schematically represented by computer 532, and datastore 534 which is schematically shown. The processors and data storeare operatively connected and enabled to communicate through a networkschematically indicated 536.

A plurality of display terminals of the types previously described areconnected to the network 536. This is represented by a display terminal538. It should be understood that in one preferred embodiment thedisplay terminals 538 may also include a processor and data storetherein. The display terminal 538 is shown schematically connected to adispenser device 540. In the embodiment shown the dispenser device 540is an electronic lock drawer of the type previously described. It shouldbe understood that a plurality of dispenser devices of the various typesdescribed herein may be used in carrying out the restocking method. Suchdispensing devices may include cabinets, refrigerators and dispensersfor varied types of medical items.

While in the system 530 the dispenser devices are shown connected to thedisplay terminal, in alternative embodiments of the invention thedispenser devices may operate as stand alone devices in the mannerpreviously described. Such devices rather than being in operativeconnection with other devices in the system on a generally continuousbasis, may have only periodic connection to other components of thesystem.

The embodiment of the invention shown in FIG. 55 also includes a readingdevice 542. Reading device 542 has generally similar characteristics tothe reading device 548 previously described. The reading device may beconnected to the display terminal 538 by a line or through othercommunications methods. In one form of the invention the reading device542 communicates through infrared signals. The display terminal 538 isin operative connection with an infrared transmitter and receiverschematically indicated 544. The reading device 542 may also be providedwith a cradle 546 similar to cradle 354 previously described. It shouldbe understood that various approaches may be used in embodiments of theinvention for communicating between the reading device and the displayterminal 538 and/or other components of the system. The reading device542 may remain at a position adjacent to an associated display terminalor alternatively may to be carried by a restocking user to variouslocations throughout the system where restocking activities areconducted. In this way the transportable reading device operates in amanner similar to the reading device used in connection with stand alonedispenser units previously described.

In one preferred form of the invention a restocking terminalschematically indicated 548 is connected to the system through network546. The restocking terminal 548 is preferably located in a stockinglocation schematically indicated 550. The stocking location ispreferably an area where supplies of medical items are prepared. Thismay be a pharmacy within a medical facility such as a hospital, clinicor treatment center. Alternatively the stocking location may be afacility where inventories of medical items are available and may bepackaged for transport. Alternatively a stocking location may comprise amanufacturing facility where medical items are manufactured.

The restocking terminal is preferably in operative connection with areport generating device 552. The report generating device in theembodiment shown is a printer which is capable of printing a restockingreport schematically indicated 554. The restocking report 554 ispreferably similar to the type previously described which includes bothhuman and machine readable indicia concerning storage locations whichrequire replenishment of the medical items therein and the type ofmedical item which needs to be replenished. In alternative forms of theinvention the report generating device may be a device which providessuch information either in a visual or machine readable form which canbe transported and/or transferred so as to facilitate the restocking ofthe locations.

In one embodiment of the invention the report generating device produceslabels with machine readable indicia which can be applied in associationwith containers for medical items. The indicia is preferably a bar coderepresentative of the storage location. The bar code representative ofthe storage location may be a location designator or indiciarepresentative of the type of medical item stored in the container.Alternatively the indicia may be a combination of both the locationdesignator and the medical item type.

Although the embodiment described produces transferable labels with thereport generating device, in alternative embodiments other devices maybe used to produce labels or alternative forms of indicia or informationwhich can be transferred to a container. This may include for exampleoptical indicia or electronic indicia including processor chips whichmay be programmed and attached to medical item containing devices.

In alternative embodiments the liners may be marked with a generallypermanent identifying indicator, such as serialized machine readableindicia. In such a system data representative of the type of medicalitem placed in each container may be input and stored in the data store.Further in a concurrent or subsequent step data representative of theindicator for the container and a particular storage location may bestored in correlated relation in a data store. This would result in thecontainer being assigned or addressed for subsequent placement in thestorage location.

The type of report generating device used and the indicia which areassociated with the containers for the various types of medical itemswill depend on the configuration and operation of the particular system.

An embodiment of a liner used in carrying out the method is shown inFIG. 56. The liner generally indicated 554 is a portable container forhousing medical items. The liner includes a front wall 556 and a backwall 558. The liner also has a pair of side walls 560. The side walls560 include a plurality of spaced projections 562. Apertures 564 extendbetween adjacent projections on the exterior of the side walls.

The walls of the liner bound an interior area generally indicated 566.The interior area is bounded by a pair of opposed inside walls 568. Theinside walls 568 include spaced slots 570 therein. The positions of theslots correspond to the projections 562 on the side walls 560.

At the top of each slot 570 are openings 572. Each of the side wallsincludes an outward extending flange portion 574. The openings 572extend entirely through the side wall and a portion of the flanges 574.As shown in FIG. 58, dividers 576 are enabled to be selectivelyinstalled in the interior area 566 of the liner. The dividers 576 aregenerally rectangular members with outward extending ears 578 adjacentthe top thereof. The liner 554 and the dividers 576 are preferablycomprised of relatively flexible plastic or other material that enablessufficient deformation so that the dividers may be manually installed inthe slots 570. The installation of the dividers enables selectivelydividing the interior area 566 of the liner into multiple compartments.The dividers 566 may have bar code or other indicia installed thereonfor purposes that have been previously discussed. In addition theinterior area 566 of the liner includes a floor 580. Bar code or otherindicia may alternatively be installed on the floor of the liner.

The interior area 566 of the liner 554 is bounded by a back wall 582.The back wall has a plurality of hinge access openings 584 extendingtherethrough. Supporting projections 586 extend between the hinge accessopenings and support a pivot portion 588 thereon. As best shown in FIG.59 pivot portion 588 is a generally round portion in cross section whichserves as part of a hinge portion for holding a lid to the liner in amanner hereinafter discussed. The liner 554 further includes a frontwall flange 590. Front wall flange 590 has an opening 592 therethroughthe purpose of which is later explained.

Liner 554 is releasibly engageable with a lid 594. Lid 594 has agenerally planar top surface 596. The lid 594 is preferably comprised oftransparent plastic material. A plurality of fingers 598 extend from afirst end of the lid. As best shown in FIG. 59, the fingers 598 arecurved members which are sized to extend through hinge access openings584. Fingers 598 are configured so they are movable in the hinge accessopenings and enable the lid 594 to be is pivotally movable thereon. Thefingers 598 are part of a second hinge portion which works incooperation with the first hinge portion on the liner to releasiblyengage the lid and liner together.

It will be appreciated from the foregoing discussion that the lid 594 isengaged to the liner 554 by positioning the lid at an angle that isgenerally 90 degrees or greater relative to the floor 580 of the liner.In this position the fingers 598 may be extended through the cooperatinghinge access openings 584. The liner 594 is then rotated to generallycover the interior area 566 of the liner, in which position theengagement of the fingers 598 and the pivot portion 588 hold the lid andliner in engaged relation at the first end of the liner.

The lid 594 further includes side wall flanges 600. Side wall flanges600 extend generally the full length of the liner along each side wall(see FIG. 61). The side wall flanges are configured so that they overliethe side wall flanges 574 of the liner when the lid is in the closedposition thereon. The lid 594 further includes a pair of spaced downwarddepending front wall flanges 602. The front wall flanges generallyextend downward and in overlying relation relative to the front wallflange 590 on the liner. A front lid opening 604 extends through theplanar top portion 596 of the lid. The front lid opening is generallyaligned with opening 592 in the front flange of the liner. When the lidis positioned in covering relation to the liner the space between thefront wall flanges 602 on the lid generally corresponds to the positionof the front lid opening 604.

The aligned openings 604 and 692 in the lid and liner respectively,enable the end of the liner and lid opposite fingers 598 to be held inengaged relation with a lock device. In one embodiment of the inventionthe lock device comprises a tamper indicating seal generally indicated606 in FIG. 60. The tamper indicating seal includes a strap portion 608.The strap portion 608 is preferably flexible and can be extended throughthe aligned openings 592 and 604. The strap portion preferably extendsfrom a body portion 610 of the seal. The strap portion is doubled backand accepted into an aperture in the body portion 610. The aperturepreferably includes one of a plurality of types of conventional one waylocks. Such one way locks enable the strap portion to be extendedthrough the aperture in one direction but prevent movement of the strapin an opposed direction. Once engaged the one way lock cannot be openedwithout breakage of the body portion or strap in a manner that would bereadily apparent upon visual observation. In this manner the tamperindicating seal 606 provides a visual indication if sealed liners areopened.

The tamper indicating seals are particularly valuable when the linersare transported by entities other than those who have the responsibilityfor loading them or unloading them into the storage locations. Arestocking user who receives a liner with a damaged tamper indicatingseal would likely be aware of the problem and can report a possibleimproper occurrence.

It should be understood that while one embodiment uses a strap typetamper indicating seal as a locking device, in other embodiments othertypes of locking devices may be used. Such locking devices may includekey type or other types of locks that have components permanentlyassociated with either the lids, the liners or both.

As shown in FIG. 60 one preferred form of the tamper indicating seal 606has a label tag 612 connected thereto. Label tag 612 is preferably sizedand configured for having machine readable indicia thereon. Such machinereadable indicia includes in the described embodiment a bar code labelwhich identifies the storage location and/or medical item in the liner.In alternative embodiments label tags may be placed on other areas ofthe lid or liner. Other forms of the invention may have generallypermanent indicia on the lid or liner.

In alternative embodiments other types of indicia may be used. Suchindicia may include for example other types of optical indicia likecomputer chips, programmable displays or other devices which can be usedto identify the liner or the contents thereof. Other embodiments may usealternative forms of information recording devices including those whichare permanently attached to the liners or lids or both.

As shown in FIG. 56 lid 594 includes four projection segments 614thereon. The segments each include two generally perpendicular wallportions 616 and 618. As shown in FIG. 61 the wall portions aregenerally arranged at the corners of a rectangle. The rectangle which isbounded by the segments generally closely conforms to a lower portion ofthe liner. The profile of the lower portion of an adjacent linergenerally indicated 620, is shown in phantom in FIG. 61. The closeconforming contour of the interior surfaces of the walls of the segmentand the lower portion of the liner enable the liners to be readilystacked when the lids are installed thereon as shown in FIG. 60. Thisfeature restricts relative movement of the stacked liners duringtransport.

To further restrict relative movement of the liners, wall portions 616which extend adjacent to the outer side walls 560 of the adjacent liner,include finger projections 622 thereon. As shown in FIG. 61 the fingerprojections 622 extend inward relative to an adjacent liner. The fingerprojections 622 extend in an aperture 564 of an adjacent liner. At leastone of the projections 562 of the side wall is adjacent to the fingerprojection when a liner is positioned in supported relation on the lid.

The preferred configuration of the segments provides for a snugreleasible engagement between a lid and an adjacent liner installedthereon. An adjacent liner is not only held in nested relation betweenthe four segments 614, but is also held at each end by engagement of thefinger projections 622 with an adjacent projection 562 on the outerwalls of the liner. This configuration enables the liners with the lidsinstalled thereon to be stacked in generally secure nested relation. Italso prevents the liners from moving relative to one another while theyare being transported. Liners with engaged lids may be stacked two,three and more high, depending on the size of stack that can be easilyhandled. However when the liners reach an area adjacent to the storagelocations the liners may be readily disengaged.

The configuration of the segments of the preferred embodiment alsoenables the stacking of liners having different sizes. For example, aliner may be sized to include a bottom portion that has a profile thatis similar in width but shorter in length than the liner just described.The exterior of such a liner includes apertures similar to the linersshown. This configuration enables holding the liner having the shorterbottom profile with the finger projections at only one longitudinal endof the liner. This limits shifting during transport of liners that havedifferent sized lower portions. In addition, liners having a shorterlower portion profile may be selectively engaged in stacked relationwith the finger projections on either longitudinal end of an adjacentlid.

In one form of the invention different sized liners are configured to beused with generally identical lids. For example, a deeper liner may beprovided with a top opening that is configured to accept the lid usedwith a shallower liner. Other deeper liners may have an opening sized toaccept identical lids, but may have a shorter lower profile so as toengage only finger projections on one longitudinal end of an adjacentlid when in stacked relation. Other configurations for liners may bemade within the scope of the invention to suit the requirements ofvaried types of dispensers and storage locations.

As shown in FIG. 57 the liners are preferably configured to be acceptedin the storage locations where medical items are held. In FIG. 57 adrawer 624 of a dispenser device such as a lock drawer module is shownin the open and extended position. The drawer 624 has a storage locationthat is configured to accept the liner 554 therein. The storage locationand the liner are preferably configured so that the liner fits snugly inthe storage location. The liner however is preferably readily removablefrom the storage location so that a substitute liner may be placedtherein.

When the liner 554 is placed in the storage location and prior to theoperation of the system, the lid 594 which covered the medical items inthe liner during transport is preferably removed. The lid may be removedin some embodiments after the liner has been installed in the storagelocation. In other embodiments the lid may be removed prior toinstallation of the liner. The time when the lid is removed may dependon the particular type of storage location involved and the preferencesof the restocking user. However as represented in FIG. 57, before thesystem is operated the lid should be removed from the liner so thatmedical items such as item 626 in the liner may be accessed or otherwiseappropriately dispensed from the dispensing device.

In a preferred form of the invention the storage locations and linersare configured so that the liners can only be positioned in the storagelocations in one orientation. This is useful for achieving a desiredorientation for the medical items, as well as to achieve a standardizedprocedure for opening the liners and for orienting machine readableindicia that is positioned on the liners. Further in some circumstancesdifferent types of medical items may be positioned within a liner, forexample in different compartments. The requirement that the liner mayonly be installed only one way helps to assure that medical items arepresented in a desired order.

It should be appreciated that while a liner suitable for use inconnection with an electronic lock drawer type dispenser device isshown, in other embodiments other types of liners or transportablecontainers for holding medical items may be used. These may includeliners suitable for use in other types of dispensers as well as linerssuitable for use in open type storage locations. The described approachof labeling the liners with indicia of the bar code type is exemplary,and other embodiments of the invention may employ other types of eitherpermanent or temporary indicia for identifying the storage locationsand/or the type of medical items held in the liners.

The steps in the method executed using the liners is further explainedwith reference to FIG. 55. In the stocking location 550 the liners arefilled with the appropriate types of medical items and the lids areinstalled thereon. This step is schematically represented by a liner628. At the stocking location the liners are preferably labeled withindicia which are indicative of the storage locations in which theliners may be installed. As previously discussed this indicia may takethe form of a bar code label which indicates the type of medical itemplaced in the liner. Alternatively the indicia may be indicative of aparticular storage location or may be a combination of location and iteminformation. The bar code indicia may be placed on the label tag of atamper indicating seal or on the liner, the associated lid or both.Alternatively the liner may have a generally permanent label and datacorrelating the type of medical item stored in the liner may be inputthrough an input device and stored in a data store.

The filling of liners at the stocking location is preferably done inaccordance with the restock reports 553. The restock reports arepreferably produced by the report generating device based on informationstored in the data store concerning which storage locations requirereplenishment. The restocking report may include removable labels whichare applied to the liners.

Because the restock report preferably includes both human readable aswell as machine readable indicia, the removal of labels therefrom maystill leave a useful report for use in connection with transporting andinstalling the liners in the proper storage locations. Other embodimentsof the invention may have machine readable indicia on the restock reportin addition to the removable labels. As a result the restock report maybe used in connection with machine reading devices even after the labelshave been removed therefrom. Alternatively the restock report and thelabels may be generated separately. In embodiments where the liners havepermanent indicia thereon the restock report may be generated by thecomputer based on the stored data indicating the medical items housed inparticular liners. The computer may assign the liner to a storagelocation where medical items of the type held in the liner are requiredand indicate the locations in the report.

After the liners have been filled and preferably sealed with the lids atthe stocking location, the liners are transported to the dispensingdevices or other locations where they will be installed. This isgraphically represented in FIG. 55 by a stack 650 of such liners. Theliners and lids are stacked in releasibly engaged relation as manyliners high as is convenient for handling. As previously indicated theliners are preferably transmitted to the storage locations along withthe restock report 553 which indicates where the liners are to beinstalled. Alternatively the restock report may be reproduced on aprinter connected to the system at the hospital ward or other facilitywhere the liners will be installed in the storage locations.

Once the liners are moved to the appropriate storage locations a useroperates the appropriate display terminal 538, reading device 542 orother apparatus for accessing the storage locations. This is preferablydone in the case of the dispenser device 540 by opening the dispenserdevice so that an interior area thereof may be accessed. In one form ofthe invention this is done by the restocking user logging onto thedisplay terminal 538 in the manner previously described, and providingappropriate inputs to indicate that they are going to conduct a restockactivity. The restocking user after appropriately logging into thereading device 542 may then read the indicia associated with the linerto be installed. This information is transmitted from the reading deviceto the display terminal which operates to determine from the nature ofthe indicia the location where the liner should be installed. This isaccomplished for example by comparing the type of medical itemrepresented by the indicia on the liner to information stored in thedata store. The processor connected to the data store determines wheremedical items of the particular type held in the liner are stored in thestorage locations adjacent the display terminal. The processor thenoperates to open or otherwise make accessible the particular storagelocation where those medical items are stored. In this example this isaccomplished by opening the appropriate drawer in the electronic lockdrawer module where the liner will be installed.

It should be understood that in alternative embodiments the indicialabeled on the liners may be directly representative of the storagelocation where the liner is to be installed. In other alternative formsof the invention or in circumstances where the particular medical itemto be restocked is not readily labeled with such indicia, a restockinguser may read the indicia off the restock report 553. Reading theindicia off the restock report may also cause the appropriate storagelocation for the corresponding item to be made accessible to therestocking user.

After the storage locations for the medical items housed in the linerare made accessible, a previously installed liner is moved from thestorage location and the new liner is installed. Alternatively once aliner has been removed from a storage location the restocking user mayscan the location indicia associated with the storage location with thereading device. This may involve for example scanning indicia in thestorage location in the dispenser device where the liner is to beinstalled. The indicia may be on a wall bounding the storage area whichaccepts the liner therein or in another convenient location.Alternatively such indicia may be on the face of a drawer in anelectronic drawer module. Location indicia may be provided on a shelfsuch as a shelf in a refrigerator or cabinet controlled by a lock or onan open shelf which supports the liner in an open storage location.

When the indicia is read from the storage location with the readingdevice the information read from the liner is compared to theinformation read from the storage location to determine if the locationis an appropriate location for that type of medical item. This may bedone directly by the processor within the reading device comparing thedata read from the label tag associated with the liner to the locationindicia. Alternatively information from the reading device may betransmitted to the display terminal which then operates to determine ifthe location where the liner is to be installed is appropriate. If it isdetermined that the restocking user may be installing the liner in animproper location, a signal is given to the restocking user. This helpsminimize the risk that restocker will place the medical items inimproper storage locations.

The process of scanning the indicia associated with the liner, scanningthe indicia associated with the storage location and replacing thepreviously installed liner with the new liner is repeated for eachstorage location where replenishment is required. It should beunderstood that in embodiments of the invention the scanning of theindicia associated with the new liner and the storage location may bedone either before or after the existing liner is removed and the newliner is installed therein. The order of the steps may vary based on thenature of indicia and the personal preferences of the restocking user.

The transparent lids enable machine readable indicia applied inside theliner to be read with the lid installed. The transparent lids alsoenables visual observation of the contents of the liner which saves timeand reduces the risk of error.

Either before or after installing a new liner in a storage location, thetamper indicating seal is broken and the lid is removed so that themedical items in the liner become accessible. This step is representedschematically in FIG. 55 by liner 632. After the interior area of thenewly installed liner is made accessible, medical items from thepreviously installed liner may be counted by the restocking user andtransferred to the newly installed liner. The number of itemstransferred is preferably input to the system by the restocking userusing the reading device 542 in the manner similar to that previouslydescribed. This transfer of medical items from the previously installedliner to the newly installed liner is represented by liner 634 in FIG.65.

In alternative embodiments of the invention the previously installedliner including the medical items which remain therein may be returnedto the stocking location for audit. Such medical items may also bereviewed to determine if their expiration date has passed or if for someother reason they should not be reused. In these circumstances the lidremoved from the newly installed liner may be installed on a previouslyinstalled liner and engaged thereto with a tamper indicting seal. Thisis represented in FIG. 65 schematically by a liner 636.

When the previously installed liners are to be returned to the stockinglocation with the lids installed thereon they may be stacked in nestedrelation in the manner previously described. This is schematicallyrepresented in FIG. 55 by a stack 638 of such liners. Alternative formsof the liners and lids may be configured to stack in nested relationwhen empty. When the medical items have been removed from suchalternative liners, the liners and lids may be segregated or stackedrandomly in the manner represented by stack 640. It should be understoodthat in situations where the liners are returned with medical itemstherein the tamper indicating seals which hold the lids in engagementwith the liner may include numbers representative of the restocking userwho sealed them in the storage location or other information thatenables tracking of where they originated. Alternatively in situationswhere indicia was printed on the lid of the new liner that was installedin the storage location this indicia may now become associated with thepreviously installed liner at that location and an indication thereofstored in the data store based on inputs from the restocking user.

When previously installed liners are returned with medical items thereinan audit is conducted at the stocking location of the medical items. Todo this the returned liners are opened as indicated schematically by aliner 642. The medical items are counted and the number compared to theinformation input by the restocking user. Of course if there is adiscrepancy or a liner is returned with the return tamper indicatingseal broken the possible problem may be promptly investigated.

Medical items removed from a returned liner may be inspected for theirsuitability for further use. If the items are not suitable for reusethey may be discarded. If the items are suitable for reuse they may bereturned to inventory or immediately placed into another liner.

At the restocking location tags which are indicative of storagelocations for particular medical items held in liners may be removed.Alternatively, other devices for storing information, such as memorychips on the liners, may be cleared. This enables the liners and lids tobe used to hold other types of medical items which are destined forstorage in storage locations other than the one from which the liner wasremoved.

The medication dispensing system of the present invention may be used inconnection with a plurality of different types of devices which storeand dispense medical items. For purposes of narcotics, which are tightlycontrolled, a medicine dispenser which holds the medical items in asecure enclosure prior to dispense and which dispenses such items in amanner that can be controlled and confirmed is preferred. Medicinedispenser 100 is such a dispenser that is used in connection withdispensing medications. A further example of a suitable dispenser isshown in co-pending U.S. Application Ser. No. 60/045,137 filed Apr. 30,1997, the disclosure of which is incorporated herein by reference.

The interior of medicine dispenser 100 is shown schematically in FIG.27. Dispenser 100 encloses a plurality of dispenser magazines 168 onlyone of which is shown. Each magazine holds a plurality of ampules, vialsor other medication holding containers 170 which are held in inclinedrelation in the magazine. Each of the containers in a particularmagazine contains a predetermined dose of a substance such as a narcoticmaterial that may be prescribed to a patient. Many forms ofcylindrically packaged medications or medical items may be held in themagazines. Medicine dispenser 100 optimally houses a large number ofmagazines, each one holding vials with a particular type of medicine.Each magazine 168 includes a dispensing mechanism later described indetail that releases containers in response to electrical signals one ata time from the lower end of the magazine. Released vials are guided ona chute 172 into a pocket 174 in a drawer 176. Drawer 176 may be asimple drawer or in alternative embodiments may be controllably lockedand unlocked by an electronic lock 178 shown schematically inside themedicine dispenser. Each magazine has a dispense verification sensor 179associated therewith. Sensor 179 is operable to detect the actualdispense of a container from a magazine. Sensor 179 may be an optical,mechanical or other suitable sensor type.

When medicines are requested at the display terminal 102, theappropriate containers from the magazines 168 are released and fall downthe chute into the pocket 174. After the vials have been released andare in position in the pocket, they may be taken. In alternativeembodiments in which the drawer is controlled, the data terminal 102, inresponse to signals from the computer 84 unlocks the electronic lock 178and enables the drawer 176 to be pulled outwardly so that the containersin the pocket may be taken.

Replenishment of the medicine dispenser 100 is accomplished by manuallyreplenishing the magazines and indicating that fact through the dataterminal in the manner previously described. To accomplish this themedicine dispenser has to be opened. This is possible only under themost secure of circumstances and through the use of a mechanical lockingsystem comparable to that which is conventionally used to securenarcotics. Normally, two keys are required to open the unit and each keyis in the possession of a different person.

The operation of the dispensing mechanism is shown in greater detail inFIGS. 14 through 26. FIG. 14 shows the vials or other containers 170 inthe magazine 168. As shown in FIGS. 15 through 17 because the magazineis tilted downward the containers tend to roll towards the front of themagazine toward an opening 180. The container adjacent the opening 180contacts a guide 182 which is dog-legged in cross section. Guide 182includes a tapered face 184 which is engaged by the first container 202in the magazine. Guide 182 further includes an arm portion 186 thatextends longitudinally adjacent the vials. Arm portion 186 has attachedadjusting pins 188 which extend through the side walls 190 of themagazine. Adjusting pins 188 extend in angled slots 192 and may be fixedat selected positions therein using nuts mounted on the pins or othersuitable locking fasteners.

The movable mounting of the guide 182 enables the magazine toaccommodate different diameter containers by moving the guide in theslots 192 to provide sufficient clearance for a container to pass ontothe guide adjacent opening 180 but not so much clearance so that thevial can fall out the opening without the actuation of the gate membersas later explained.

As best shown in FIGS. 18 through 20, a front gate 194 and a back gate196 are mounted adjacent to opening 180. The front gate and back gateare mounted on a front gate shaft and a back gate shaft 198 and 200respectively.

As shown in FIG. 18 in the inoperative position of the gate membersfront gate 194 engages the underside of first vial 202 adjacent opening180. The end of front gate 94 engages container 202 at a positionoutward towards opening 180 from a location on the surface of thecontainer diametrically opposite where container 202 engages taperedface 184 of guide 182. As a result, the container 202 is prevented frompassing out through opening 180. In this position any force applied tocontainer 202 (if it could be accessed) would tend to be resisted bycompressive forces making it very difficult for the container to bemanually removed. In the inoperative position of the magazine shown inFIG. 18 the back gate 196 has its upper end extending parallel to abottom wall 204 of the magazine. As a result, in this position the backgate does not interfere with movement of the containers.

In the actuation sequence for dispensing a container, the back gaterotates in a clockwise direction to the position shown in FIG. 19. As itdoes this the back gate begins to move to a position blocking thecontainer immediately behind container 202 in the magazine from movingtoward the opening 180. In the position shown in FIG. 19 the front gate194 remains in its original blocking position holding container 202 inthe magazine.

After the back gate has begun to rise as shown in FIG. 19, the frontgate begins to rotate in a clockwise direction toward the position shownin FIG. 20. As the front gate 194 rotates container 202 is no longerheld in the magazine and passes out the opening 180. The back gatehaving fully rotated as shown in FIG. 20, holds the next container inthe magazine from moving until the front gate returns to its originalposition shown in FIG. 18 When this occurs the back gate returns to itsoriginal position allowing the containers to roll forward and the nextcontainer is now in the position of container 202.

In one preferred embodiment of the invention, the slots 192 are orientedsuch that for any size container reasonably accommodated in themagazine, the front and back gates are positioned so that the front gate194 may assume an over-center blocking position in the closed positionand the back gate can move to prevent the dispense of more than onecontainer at a time. This ensures that with each cycle of the front andback gates only one container is dispensed.

The actuating mechanism for the front and back gates is shown in FIGS.21 through 26. As shown in FIG. 21 the actuating mechanism for the gatesincludes an electrical solenoid 206. Solenoid 206 has an actuatingplunger member with a pin 208 extending traversely therefrom. Pin 208extends traversely in a first slot 210 in a first actuator plate 212which is attached to the front gate 194. Pin 208 also extends through anopening 214 in a second actuator plate 216 which is attached to backgate 196. As best shown in FIG. 22 first actuator plate 212 has atraversely extending finger 218. In the position of the front gate shownin FIGS. 21 and 22, finger 218 engages a detent 220 in the secondactuator plate 216. The purpose of detent 220 is to prevent finger 218and front gate 212 from moving in a clockwise direction whenever thesecond actuator plate 216 is in its inoperative position as shown inFIGS. 21 and 22. This prevents a person who may gain access to the frontof the magazine from being able to deflect the front gate so as to causethe containers to be removed from the magazine.

As shown in FIGS. 23 and 24 the actuation of solenoid 206 by anelectrical signal from the data terminal causes pin 208 to move secondactuator plate 216 in a clockwise direction. This causes back gate 196to move upward and detent 220 to disengage from finger 218. As a result,front gate 194 may move only after back gate 196 has risen so as toblock the dispense of further containers. Upon further movement of pin208 by solenoid 206 the front and back gate move to the positions shownin FIGS. 25 and 26. In these positions the front gate is rotated so asto release container 202 while the back gate is extended fully upward soas to prevent the discharge of the next container in the magazine.Thereafter, discontinuance of the electrical signal to solenoid 206returns the gate members to their original positions and allows the nextcontainer to assume the position adjacent to the opening from themagazine.

The dispensing mechanism of the present invention enables the controlleddispense of one container at a time from the magazine in response to anelectrical signal. This assures that only the requested medication isdispensed. The same magazine may be readily adapted to containers oritems of varying diameter by adjusting the position of guide 182. Themagazine also accommodates containers of different lengths. In addition,the gate members are suitably secure so as to avoid tampering by personswho might attempt to gain access to the interior of the medicinedispenser 100 through the dispenser drawer 176.

The dispensing mechanism also assures that the requested medical itemhas been dispensed. This is assured by using signals generated by sensor179 to minimize the risk that a dispense will be recorded which has notactually occurred due to a malfunction. Circuitry in the dispenser isconnected to the sensor 179 and transmits signals when a containerpasses out of a magazine. These signals are checked to see if they aregenerated when a signal to dispense to the corresponding magazine isgiven. The dispense of any item from a location and the provision of asuch item to a patient is only recorded in the computer data store whenthe dispense is verified by the sensor associated with the magazine.Alternatively, in other embodiments a bar code reader may be installedin the dispenser and bar code applied to the containers to verify notonly the dispense but the type of item dispensed.

Although in the above described embodiment of the medicine dispenser thegate members are shown as extending the entire width of the magazine, inother embodiments the gate members may have other configurations and maybe of different designs so as to extend only a portion of the width.Although in the preferred form of the invention the magazines extend indownward tilted relation in other embodiments they may be arranged toextend vertically. In such alternative embodiments guides may beprovided to hold the containers adjacent to plate 204. Further, thecontainers may be dispensed in a vertically upward direction throughincorporation of spring loading to bias the containers upward in themagazine. A fudamental aspect of the invention is that the gate memberwhich corresponds to the front gate member engages the container in anover-center position with regard to where the container contacts thetapered face, and the back gate member moves in synchronized relationwith the front gate member to prevent the dispense of more than onecontainer at a time.

The system for monitoring and dispensing medical items which includesthe hook registers, box registers, electronic lock drawer, refrigeratorlock modules and medicine dispenser previously described may alsoinclude or be used with other types of devices. These may includeautomatic dispensing devices as well as manual devices for which theinventory and use information can be input as a matter of practice at aconveniently located data terminal. The system of the present inventionis highly adaptable to accommodate medical facilities of varying size.As the system of the present invention is also connected to a variety ofcomputers which include data stores, a wide variety of parameters may bemonitored and evaluated so as to avoid conditions of waste, fraud andabuse.

A further alternative embodiment of a system of the present invention isshown in FIG. 62 and is generally indicated 650. System 650 is generallysimilar to system 322 shown in FIG. 40. Certain of the componentsdiscussed in connection with the system shown in FIG. 40 are also shownin connection with system 650. It should be understood that thesecomponents operate in a manner similar to that previously described andthat other components described in connection with system 322 of FIG. 40may also be included in or used in connection with system 650.

System 650 is an exemplary embodiment of a system of the invention wheremedical items which have been tracked to the point of being taken by auser for use by a patient are further tracked to the point of giving theparticular medical items to the patient. As previously discussed whenused in this description the act of “giving” a medical item to a patientincludes any use of the medical item in connection with treatment of thepatient.

In system 650 report generating devices are used for generating reports.These include for example report generating device 384 which generates areport 388. In system 650 a report generating device 652 such as aprinter is used to generate a hard copy report 654. A report generatingdevice 656 which includes an output screen produces a display 658 whichis an electronic report. In each of these embodiments reports aregenerated responsive to data stored in the data store 326 in response tooperation of computer 324. Of course as previously discussed thiscomputer and data store are exemplary, and in embodiments of theinvention, the computer and data store may actually comprise a pluralityof operatively connected computers and data stores.

The reports generated by the report generating devices preferablyinclude information concerning patients and medical items that have beenprescribed for the patients. The reports generated may also includeother information such as the location of each patient and the times orfrequency that particular medical items have been prescribed for use inthe treatment of patients. Like the reports previously discussed, thereports generated by the report generating devices of system 650 mayinclude machine readable indicia which may be read by a reading devicefor purposes of carrying out functions such as dispensing and trackingactivities. While in the described embodiment the use of bar code isdiscussed as the machine readable indicia, it should be understood thatin other embodiments of the invention other forms of machine readableindicia may be used.

In the embodiment of the invention shown, reading devices are used toread the machine readable indicia on the reports for purposes ofdispensing and tracking the medical items. A reading device 660 operatesin a manner similar to reading device 348 previously described. Readingdevice 660 like reading device 348 may be used to scan indiciarepresentative of a patient and/or a medical item prescribed for thepatient, presented on a report generated by one of the report generatingdevices. In response to scanning the patient indicia, the medical itemindicia, or both, a user operating readers 660 may cause medical itemsto be dispensed or otherwise made accessible, such as from medical itemholding devices 344, 346 or 527 previously discussed. By reading suchindicia the reading device also causes data to be stored in the datastore representative that a particular medical item has been taken foruse by a patient. Of course as previously discussed, the operation ofdispensing a medical item or inputting the information to indicate thatthe medical item has been taken for use by a patient may be done throughinputs to a reading device or to a display terminal such as displayterminal 338 shown, or to both.

In the embodiment of the invention schematically represented in FIG. 62,the report generating devices may generate a report that indicates themedical items which the system data store indicates to have beenprescribed for particular patients. These prescribed item reports alsopreferably include machine readable indicia corresponding to theprescribed medical items. These prescribed item reports may be identicalto or the same reports that are used to dispense medications.Alternatively the prescribed item reports may be generated specificallyfor use in connection with giving medical items to patients. Theprescribed item reports may be hard copy reports which may be taken to abedside of a patient by a person administering medication. Alternativelyin the case of electronically generated reports such as those generatedby display 658, the reports may be generated on screens or other outputdevices adjacent to the bedside of a patient.

In the exemplary system of FIG. 62 portable terminals such as terminal652 are used for recording the giving of medical items to a patient atthe patient's bedside. The portable terminals 652 include a networkconnection device for communicating with the network 328. The networkconnection device may employ wireless connection methods of the typepreviously discussed, or alternatively may include physical connectionssuch as electrical contacts. In the exemplary embodiment a docking port654 is shown for accepting the portable terminal 652. The docking port654 may operate in a manner similar to the cradle used in connectionwith reading device 348. The portable terminal may operate in connectionwith the docking port to download data from the portable terminal 652,as well as to upload into the terminal configuration and other data. Asschematically represented in FIG. 62 the portable terminal 652 includestherein a data store schematically represented 666. It should beunderstood that in embodiments of the invention the prescribed itemreport data may be loaded from the system into the data store 666 of theportable terminal 662. This may enable a user to execute the functionsof the portable terminal described hereafter without the need ofutilizing a separate prescribed item report external of the terminal.

In the exemplary form of the portable terminal, the terminal includes atleast one input device 668 and at least one output device 670. In theexemplary embodiment shown the input device includes keys and the outputdevice includes a screen. However it should be understood that in otherembodiments other types of input and output devices may be used. Itshould further be understood that portable terminal 662 may inembodiments of the invention operate in a manner similar to a personaldigital assistant which may receive inputs and instructions by way of astylus or similar device brought adjacent to a screen or other outputdevice thereon. Various types of portable terminals may be used inembodiments of the invention.

Portable terminal 662 of the described embodiment further includes acommunications device 672. Communications device 672 is suitable for usein communicating messages between the portable terminal and otherdevices. For example in exemplary embodiments of the invention thecommunications device may include an infrared transceiver or otherwireless type communication device. The communication device 672 mayalso be used for communicating with the remainder of the system throughthe docking port 654 or through other communication devices that areconnected to the network 328.

Exemplary portable terminal 662 further includes a terminal readingdevice 674. In the exemplary embodiment the terminal reading device 674includes a stylus for reading machine readable indicia such as bar code.The terminal reading device 674 serves as a further input device for theterminal 662. In alternative embodiments the reading device may beincorporated into the housing of the terminal or into other connecteddevices. Further the terminal reading device 674 may in embodiments ofthe invention include other functions such as a stylus for inputtingdata into an input device of the terminal. The terminal reading device674 may also in other embodiments provide an input device for readinginformation provided by other instruments such as instruments used formonitoring bodily functions and vital signs of a particular patient. Ofcourse this may also be done in alternative embodiments through thecommunications device 672, or other receiving devices connected with theportable terminal.

In the embodiment of the invention shown patients are generallyassociated with beds schematically indicated 676, 678 and 680. In theuse of the portable terminal 662 medical items are tracked to the pointof giving the medical items to the patients in the beds or adjacent thepatient's bedside. Of course it should be understood that in othersystems patients may not necessarily be associated with beds but ratherwith wheelchairs, rooms or the like. The exemplary embodiment of thepresent invention is equally applicable to and may be used in connectionwith such systems.

In the described embodiment each individual patient is associated withat least one patient associated item. The patient associated itempreferably includes an item including machine readable indicia that isin proximity to the patient. For example a patient of associated itemmay include a band 682. Band 682 may be applied around a wrist, arm orleg of a patient. The band may include machine readable indicia thatcorresponds to the patient and/or other information. Alternatively thepatient associated item may include a bed label such as label 684applied in connection with bed 676. Alternatively the patient associateditem may include machine readable indicia on a bedside chart such aschart 686 shown in connection with bed 678. Further alternativeembodiments of the invention may have the patient associated iteminclude a bedside terminal such as terminal 688 shown in connection withbed 680. Bedside terminal 688 may include a screen similar to screen 658which produces machine readable indicia thereon. Bedside terminal 688may also be in connection with network 328 through various types ofcommunication devices. For example in FIG. 62 bedside terminal 688 isshown in communication with a wireless transceiver 690. Of coursevarious types of contact or contactless communications may be used forcommunicating between the network 328 and the bedside terminal 688. Inexemplary embodiments of the invention the bedside terminal 688 maycommunicate with the portable terminal 662 through the communicationsdevice 672 and a compatible communications device operatively connectedto the bedside terminal.

In operation of the system 650 represented in FIG. 62 a record is madeusing the portable terminal 662 that a medical item has been given to apatient. The information concerning the giving of the medical item isstored in the data store 666 of the portable terminal and is transferredthrough the network 328 so that data representative of the fact that themedical item has been given to the patient is stored in the data store326. The procedure used for accomplishing this may vary depending on theconfiguration of the portable terminal 662 as well as the preferences ofthe institution operating the system and the user giving the medicalitems to the patient.

In one exemplary embodiment a user signs on the portable terminal 662 ina manner similar to signing on to a reading device such as readingdevice 348. The user may scan machine readable indicia on their badge orother identification article with the terminal reading device 674. Theuser in addition or in the alternative may be required to insert apersonal identification number through the input device 668 of theportable terminal. Alternatively the portable terminal may include afingerprint reader or other input device for receiving identifyinginformation which confirms that a user is authorized to operate theportable terminal.

Once the user has signed on to the portable terminal, the user may usethe terminal reading device 674 to scan machine readable indiciaindicative of a medical item being given to the patient proximate to thetime it is given to the patient at the patient's bedside. The user mayalso scan the patient associated item to confirm and cause to be storedin the data store 666 of the portable terminal that the medical itemcorresponding to the read indicia was given to the patient. Inembodiments of the invention the configuration stored in the portableterminal 662 may cause such information to be stored in response to thescanning of indicia representative of a medical item and a patientassociated item within a particular time period. Alternatively or inaddition, the user may provide additional inputs through one or moreinput devices on the portable terminal to indicate the giving ofparticular medical items to the patient.

The portable terminal 662 in the described embodiment is carried to thebedside of a plurality of patients and the process repeated for eachmedical item given to each respective patient. This causes a record tobe stored in the data store 666 of the portable terminal of thepatients, the medical items that have been given thereto, as well asother information. Such other information may include the time of givingthe medication, the condition of the patient at the time the medicalitem was given, readings of devices monitoring the condition of thepatient as well as other information. The variety of information thatmay be recorded depends on the capabilities of the input devices, theterminal reading device and the configuration of the system. After theinformation concerning the giving of medical items to the patients iscaptured in the portable terminal 662, the portable terminal of theexemplary embodiment is returned to the docking port 654. Theinformation related to the giving of medical items to the patients isthen transferred from the memory in the portable terminal through thenetwork 328, and data representative of such information is stored inthe data store 326.

In embodiments of the invention which employ bedside terminals 688, thebedside terminals may operate to receive messages from the portableterminal 662. These messages may include information representative ofthe medical items being given to the patient as well as otherinformation. This information may be recorded in the bedside terminalfor purposes of charting the progress of treatment of the patient. Thisinformation may be transmitted from the bedside terminal 688 through thewireless transceiver 690 to the remainder of the system. In suchembodiments this may avoid the need for the transmission of suchinformation from the portable terminal through the docking port. Inalternative embodiments the information transmitted from the portableterminal and the bedside terminal may be compared to insure accuracy. Ofcourse it should be understood that in embodiments of the invention, theportable terminal 662 may communicate through the network 328 withoutthe use of a docking port and that information stored in the portableterminal may be communicated on a real time basis or periodically in abatch mode.

In alternative embodiments where the prescribed item report data isstored in the memory of the portable terminal 662, the user may reviewthe indicia presented through the output device 650 of the terminal. Theuser may also may input the inputs indicative of the medical itemsand/or the giving of items to patients through the input devices on theportable terminal. In such embodiments the reading of the patientassociated items may not be necessary to record the giving of medicalitems to the patient. However even in such embodiments the reading ofthe patient associated items may be preferred as a verification step toassure that medical items are given to the proper patients as indicatedin the prescribed item report. Of course various combinations forreading indicia representative of the prescribed medical items forpatients and patient associated items may be used to indicate and/orconfirm the giving of medical items to patients.

In the exemplary system 650 an administrator terminal 692 is shown inconnection with the network 328. The administrator terminal 692 may inembodiments of the invention be an administrator work station (AWS) ofthe type previously described or other type terminal. The administratorterminal 692 is in operative connection with a report generating device694 which generates reports schematically indicated 696. In embodimentsof the invention the administrator terminal 692 is used to determineinstances where medical items which have been taken for use by patientshave not been administered to the patients. This is accomplished throughoperation of the computer 324 from the information stored in the datastore 326. It will be recalled that the taking of the medical items forthe particular patients is represented by data stored in the data store.Likewise in embodiments of the invention the particular user who hastaken such medical items by causing them to be dispensed or otherwise,is also represented by data that is stored in the data store. After themedical items have been given to the patient the data representativethereof as well as other information such as the time of giving themedical item is also represented by data that is stored in the datastore. Through operation of the administrator terminal 692 and thereport generating device 694, instances where medical items that havebeen taken but which have not yet been recorded as given to the patientsmay be identified. Such information may be useful in tracking errors orirregularities in the giving of medical items. Devices in connectionwith the system for returning or wasting of medications in the manner ofthe patent disclosures which have been incorporated herein by reference,may provide data to the system which may be analyzed and reportedthrough the report generating device 694 to identify instances wheremedical items were returned to the system rather than being given topatients. The administrator terminal 692 may also operate to include inthe reports 696 the reasons why such items were not given to patients.Such information may be particularly useful in situations where themedical items involved were narcotic items which require close tracking.

The exemplary embodiment of the system 650 is useful because it providesfor storing data in the data store which records steps in thedistribution cycle of medical items. This includes tracking medicalitems from the source such as a pharmacy or other supply, to the storagelocations or dispensing devices. This is accomplished through thetracking during the restocking function. In addition medical items aretracked from the dispensing or taking of the medical items for use bythe patient. The medical items are further tracked to the giving of themedical items to the patients or alternatively the return of medicalitems that are not given to a return/retrieve device. The medicationsmay be further tracked from the return/retrieve device through disposalusing the liner tracking procedures or through other restockingactivity. The system thus enables more accurate tracking and minimizesthe risk of losses or abuse.

A further alternative embodiment of a system of the present invention isindicated 700 and is schematically shown in FIG. 63. System 700 isgenerally similar to system 322 shown in FIG. 40. System 700 however hasthe additional capability of enabling patients to dispense medicationsthemselves through a self service dispenser. System 700 also enablespatients to obtain their medications on an outpatient basis as well asto make payment for medications using a credit or debit card account.The exemplary embodiment of the System 700 also enables charging abenefits provider such as the patient's health insurance company, forthe amount that they owe for the medical item given to the patient. Thisassures that the patient's personal account is only charged theappropriate co-pay amount.

In the operation of system 700 data concerning medications that areprescribed for patients are input through a physician terminal 702.Physician terminal 702 may be located in a physician's office. This maybe a physician's office associated with a medical practice located inproximity to a hospital, clinic or similar inpatient care facility.Alternatively the physician terminal may be located remotely from thecomputer 324 and may connect to the network 328 via a remotecommunications method such as via modem or by a public or privatenetwork. Alternatively the physician terminal 702 may be one of theterminals that is used for entering prescription data for patients thatare being treated on an inpatient basis within a hospital or otherresident care facility in which the system 700 is used.

In the system 700 the physician terminal is used to input prescriptiondata for a patient. The prescription data preferably includesinformation such as the patient name, the medical item prescribed andthe physician's name. In addition the physician data may include thecondition for which the medication has been prescribed and at least oneinstruction for its use. Such instructions may include for example thenumber of tablets or capsules that the patient is to take within a giventime period. Alternatively for other types of medical items, theprescription data may include instructions for application of themedical item. The prescription data may also include instructions orwarnings concerning the medication and possible side effects, and anyinformation that the physician may find appropriate to include in theprescription data. The prescription data input through the physicianterminal 702 is transmitted through the network 328 to the computer 324.The computer 324 causes data representative of the prescription data tobe stored in the data store 326. As can be appreciated the prescriptiondata input through the physician terminal 702 may be similar to theprescription data previously described that is stored in the data store326 for patients who are treated as inpatients in the facility thatutilizes the system of the invention.

System 700 further includes a database 704 in operative connection witha computer 706. Data store 704 includes data representative of paymentrules which are used for determining benefit amounts that patients areentitled to receive from a benefits provider. These payment rulesinclude information necessary to calculate the benefit amounts that thebenefit provider is required to pay when a patient receives medicalitems in the course of medical treatment. Data store 704 in addition toincluding payment rules for one or more benefit plans also preferablyincludes data representative of benefits providers for other entitiesrequired to make payments that are associated with each particularbenefit plan. In the exemplary embodiment the benefit provider is thepayor entity who is generally required to make at least a partialpayment of a benefit amount for medical items used to treat patients.Data store 704 further includes data representative of patients and thebenefit plans or benefit providers with which particular patients areassociated. Computer 706 operates responsive to the data stored in thedata store 704 and information regarding a patient and a medical itemprescribed for the patient, to determine the benefit plan and therespective rules for receiving benefits by the patient. Computer 706 isalso preferably operative in response to the stored data and otherinformation to determine the benefit amount that is required to be paidby the benefits provider on behalf of the patient as well as any co-payamount that a patient receiving medical items is required to paypersonally for the medical items.

It should be understood that while in the exemplary embodiment the datastore holding the benefit plan rules is shown as a separate data storein connection with a separate computer, in embodiments of the inventionthe benefit plan information may be stored in database 326 and processedby computer 324. Alternatively in other embodiments the payment rulesand benefits plan information may be divided between a plurality ofcomputers and associated data stores.

In the exemplary system 700 network 328 is in operative connection witha communications processor 708. In the exemplary embodimentcommunications processor 708 is a firewall or similar communicationsdevice that operates to enable network 328 to communicate with othernetworks while preventing unauthorized access from outside the network328. It should be understood that while in the exemplary embodiment aserver type firewall is used, in other embodiments other types ofcommunications devices and approaches may be used.

In system 700 communications processor 708 is connected through anetwork 710 to a computer operated by at least one benefits providerschematically indicated 712. In an exemplary embodiment network 710 is apublic network that is capable of communicating with a plurality ofcomputers including a plurality of computers operated by differentbenefit providers. Each computer operated by a benefits provider ispreferably operative to receive information representative of benefitamounts that each respective benefits provider is obligated to pay onbehalf of patients who are enrolled in the their respective benefitsprogram. The computers operated by the benefits providers are preferablyoperative in response to receiving information concerning benefitamounts due, to issue the appropriate payments to the institutionproviding medical items to patients. This includes amounts due formedical items provided to patients by self service dispensers in amanner hereinafter discussed.

Communications processor 708 is also preferably operative to connectnetwork 328 to other remote computers such as remote computer 714.Computer 714 preferably has in connection therewith a data storeschematically indicated 716 which holds a registry of medical historyinformation concerning patients who may receive medical items from thesystem. Data store 716 may include a national or regional repository ofmedical history information and may be operated by public or privateauthority. Alternatively computer 714 and the information in data store716 may be provided by benefits providers for a consortium thereof.Alternatively the medical history information accessible throughcomputer 714 may be medical history information available in a computerat another medical care facility where a particular patient haspreviously received medical treatment. As later explained the medicalhistory information accessible through computer 714 may be operated tosupplement history information that is available in the HIS System 332operated by the particular care facility in which the system of theinvention is operating.

In the exemplary system 700 network 328 is also in operative connectionwith a plurality of self service dispensers one of which isschematically indicated 718. Dispenser 718 is in connection with thenetwork 328 through the communications processor 708 and through anetwork 720. Network 720 may include a public or private network of anytype suitable for communicating with the dispenser 718. Network 720 mayinclude a telephone or data network which is connected to the dispensereither on a permanent or a periodic dial up basis.

In the exemplary embodiment self service dispenser 718 is generallysimilar in its operation to dispenser 100 previously described.Dispenser 718 is selectively operative in response to messages fromcomputer 324 to selectively dispense medical items. Self servicedispenser 718 also includes a user interface 722 generally similar tothe interface used in connection with the display terminal previouslydiscussed. Interface 722 includes input devices such as a keypad 724,card reader 726 and touch screen 728. User interface 722 also includesan output device which in the exemplary embodiment is the touch screen.It should be understood that while in the exemplary embodiment certaininput and output devices are shown, in other embodiments other types ofinput and output devices may be used. While in dispenser 718 the inputand output devices are shown integrated with the housing of thedispenser, in other embodiments of the invention the input and outputdevices may be mounted on other structures generally adjacent thereto.

In the exemplary embodiment of the self service dispenser 718 thedispenser housing includes a receipt printer schematically indicated730. Receipt printer 730 which is schematically represented by a receiptoutlet in the dispenser is operative to provide patients using the selfservice dispenser with written receipts for medications dispensed and/ortransactions conducted at the dispenser. Exemplary dispenser 718 furtherincludes a label printer schematically indicated 732. Label printer 732operates in a manner later discussed to print and provide labels to apatient using the self service dispenser.

Network 328 is also in operative connection through the communicationsprocessor 708 in the exemplary embodiment, with financial transactionprocessing systems. In the exemplary embodiment schematicallyrepresented, network 328 is in operative connection with a credit cardprocessing system schematically indicated 734 and a debit cardprocessing system schematically indicated 736. The network 328operatively connects to processing systems 734 and 736 through a network738 which in the exemplary embodiment is one or more private transactionprocessing networks. Of course this configuration is exemplary and inother embodiments financial transactions may be processed through othersystems and networks including public networks such as the Internet.

The operation of the system 700 is represented in the logic flow shownin FIGS. 64-67. To enable operation of the system information concerningbenefit plans and the rules for providing benefits associated with thosebenefit plans is first stored in the data store 704. This is done in astep 740. Patient identification information which indicates theidentities of each patient and the particular benefits plan and/orbenefits provider with which each such patient is associated is alsostored in this step. Such information may be input to the system throughthe physician terminal 702, at the administrator work station, admittingwork station or other computer connected to the network 328. Theinformation concerning benefit plans and plan rules may also be importedfrom another system into the database 704.

When a physician prescribes a medication for a patient who will receiveit through the self service dispensing terminal, the prescription datais entered through the physician terminal 702. The data entered throughthe physician terminal generally includes prescription data includingdata typically entered in connection with medications which have beenprescribed for patients on an inpatient basis as previously discussed.The prescription data may include for example the patient name,physician name, medical item, condition treated and one or moreinstructions for taking or using the medication. This prescription datamay also include other data related to the patient or a medication, suchas potential side effects or the term during which medication is to betaken. The prescription data may also include other identifying indiciasuch as the patient's member number associated with their respectivebenefit plan as well as benefit plan information and other data. Theprescription data is entered into the system in a step schematicallyindicated 742. The prescription data is transferred through the network328 to computer 324 and data representative of the prescription data isstored in the data store 326.

In the exemplary embodiment of the invention a check is made concerningthe prescription data prior to giving the prescribed items to thepatients for possible adverse circumstances. This process is indicatedin FIG. 64 in a step 744. In an exemplary embodiment the checking step744 includes checking the medical history information related to thepatient. This may include for example checking whether the patient maybe allergic to particular medication prescribed and whether themedication which has been prescribed for the patient may have aninteraction with other medications that the patient is currently taking.The checking step 744 in the exemplary embodiment is preferably donethrough the pharmacy system 334 which checks local history data that isavailable in connection with the system or facility where the medicationhas been prescribed which is generally the HIS system 332. Alternativelyor in addition, a check may be made of the remote repository of medicalinformation. This may be done by exchanging messages with computer 714through the network 710. The remote history information which isschematically indicated as stored in data store 716 and which isaccessed through computer 714, may be medical history data stored in apublic or private repository. This may include for example informationstored in other hospitals or treatment care facilities where the patienthas been treated. The repository may be one maintained by the patient'sbenefit plan provider or HMO. It may include a repository maintained ina computer in the offices of the patient's other treating physicians. Inembodiments of the invention several remote repositories of medicalhistory data may be checked for information concerning the patient.Using this information the pharmacy system 334 makes a determinationwhether it is acceptable based on the patient's medical history andother information to dispense the medication to the patient. Thisdetermination step is represented by step 746.

If in the step 746 it is determined that there is some reason why it maynot be appropriate to give the prescribed medication to the patient, thesystem operates to send a message back to the physician advising thephysician of this. This is preferably done through an electronic messageto the physician terminal 702. Alternatively the message may be providedthrough a phone call from the pharmacy operation or through otherappropriate means. The step of notifying the physician is represented inFIG. 64 by a step 748. In response to being notified in step 748 thephysician prescribing the medication may take appropriate action such ascontacting the patient and/or providing for a different course oftreatment for the patient with a different prescribed medical item.

Alternatively, or in addition, the repository or repositories of patienthistory data may be checked when the patient identifies themself to theself service dispenser. In some systems it may be advisable to waituntil the patient actually requests medical item to check for possibleadverse situations (or to check again) as the history data may have beenupdated after the medical item was prescribed.

Assuming that it is acceptable to provide the prescribed medical item tothe patient information concerning the patient and the prescription datais stored in the database 326 in a manner which indicates that theprescribed medical item is to be given to the patient. This isrepresented by a step 750.

In operation of the exemplary system shown in FIG. 700 once the patientand corresponding prescription data has been stored in the system, theinformation remains waiting for the patient or other person acting ontheir behalf to access the information through the system. This isrepresented in a step 752. In some circumstances such data may reside inthe system for some time without the medical items that were prescribedfor the patient having been taken. The computer 324 in the exemplaryembodiment is operative to monitor the situations where a prescribeditem has not been taken by the patient and if a set period elapses anotification is given. In an exemplary embodiment the notification isgiven to the physician prescribing the medical item for the patient toadvise that the patient has not taken the medication. The processexecuted by the computer 324 in determining if a prescription hasexisted for too long without being taken by the patient is representedby a step 754. This step of notifying the physician that the patient hasnot taken their prescribed medication from the system is represented bya step 756. Of course upon being notified that the patient has notreceived their medication the physician may take appropriate action tofollow up with the patient to determine if there is a problem and/or whythey have not taken their medication.

In the usual operation of the exemplary system a patient eventuallyapproaches a self service dispenser such as dispenser 718 to receivetheir prescribed medication. This process generally begins by thepatient entering identification data at the self service dispenser. Thisis represented in FIG. 65 by a step 758. The process of the patientidentifying themself depends on the particular embodiment of the system.For example the patients may identify themselves by entering a uniqueidentifying number such as a patient number or their member numberassociated with their particular benefit plan and/or provider.Alternatively the patient may identify themselves by entering a socialsecurity number or similar identifying data. In other embodiments apatient may simply input their name to the system through the keypad 724or other input device. Also as represented in a step 760 in an exemplaryembodiment a patient inputs a credit or debit card into the card reader726 of the self service dispensing terminal. It should be understoodthat data encoded on such a card such as the patient's name may also beused to identify the particular patient.

In response to receiving the patient identifying information and/orcredit or debit card data at the self service dispensing terminal, theinformation is communicated through the network 720 into the network328. One or more computers such as computer 324 operates to determine ifthere is data in the data store 326 corresponding to one or more pendingprescriptions for the identified patient. This is represented in a step762. A determination is made in a step 764 by the computer whether thereare prescriptions pending for the particular patient. If noprescriptions are found the terminal 718 displays this to the patientthrough the output device 728. This is represented by a step 766. If anyprescriptions are found in the data store, messages corresponding to theprescriptions are sent by the computer 324 through the network 328 andto the self service dispenser 718. If the system is so programmed, thepatient's medical history information may also be checked at this timefor possible adverse consequences from the patient's use of theprescribed medical item.

The prescription data or selected portions thereof are displayed to thecustomer through the output device 728. This is represented by a step768. In this exemplary embodiment of the invention at least a portion ofthe prescription data is displayed to the patient so that the patientmay make a determination that the prescription information stored in thedata store is consistent with their understanding of the medicationsthat have been prescribed for them. The prescription data will generallyinclude items such as the name of the doctor and the condition for whichthe medical item has been prescribed. The customer will be able tocompare this information to their understanding of their condition andcourse of medical treatment. If by some chance an error has been madethis will likely be apparent to the patient from the prescription datawhich is being displayed to them.

When the prescription data has been displayed to the patient through thedispenser terminal 718, messages from the computer 324 or alternativelythe computer operating in the dispenser 718, operate to prompt the userto provide an input to indicate whether or not the prescription datathat is being displayed is correct to their understanding. This isschematically represented in a step 770. The patient then responds at astep 772 to indicate whether they believe that the displayedprescription data is correct. If the patient indicates that the data isnot correct a message indicative of this input is transmitted backthrough the system to the computer 324 which notes the discrepancy inthe data store. This is represented by a step 774. The computer 324 inthe exemplary embodiment also operates to notify the physician with amessage that the patient indicated a discrepancy and that theprescription data was incorrect. This was indicated at the step 776. Inresponse to receiving such a message the physician may contact thepatient or take other steps to determine the nature of the problem. Theself service dispensing terminal in response to the patient indicatingthat they do not believe that the prescription data is correct, operatesas indicated in a step 778 to display an appropriate screen through theoutput device 728. This screen may apologize to the patient for theinconvenience or given another appropriate message. The terminal thenproceeds in response to computer 324 or a computer operating in thedispenser terminal to execute a sequence to close the transaction whichis later discussed.

If in the step 772 the patient indicates that they believe that theprescription data is correct a message indicative thereof is transmittedback through the network to the computer 324. The computer 324 thenoperates to calculate a cost associated with the medical item that is tobe dispensed to the patient. The cost is determined from the informationincluded in the data store. This is represented in a step 780. Inresponse to the cost of the medical item to be provided beingdetermined, the computer 706 or other computer in the system operates inresponse to the benefit plan information and rules to calculate thebenefit plan information which applies to the patient, the particularmedical item that has been prescribed and the cost. This includes in theexemplary embodiment determining the benefit provider associated withthe patient. It also includes calculating the benefit amount that thebenefit provider is required to contribute towards payment for themedical item, as well as the amount of any co-payment that the patientis required to make. This is represented by a step 782.

In response to determining the amount of the benefit and co-payment anelectronic message is sent to the dispenser 718. This message includesdata corresponding to the cost for the medical item and particularly theamount of the patient's co-payment. This information is displayed to thepatient through the output device 728 of the terminal in a step 784shown in FIG. 66. At a step 786 the output device of the dispenserterminal is operated to display a prompt requesting the patient toindicate if they accept the charge for the amount of the co-payment.

In response to the prompt given to the patient, the patient at a step788 provides an input which either indicates that they do not accept thecharge or that the charge will be accepted. In situations where thepatient does not accept the charge, messages are transmitted to thecomputer 324 or other connected computer which generates a message backto the dispensing terminal 718. In response to the message received bythe dispensing terminal the terminal operates to provide the patientwith contact information for purposes of resolving the apparentdisagreement concerning the amount that the patient is going to berequired to pay. This is indicated by a step 790. Providing the patientwith such contact information may include displaying information to thepatient through the output device 728 and/or providing the informationto the patient in hard copy with the printer 730. In addition toproviding the patient with information concerning who to contact tocorrect the apparent problem, the computer 324 also operates asrepresented in a step 792 to notify the physician of the apparentproblem. This enables the physician to follow up with the patient to besure that there medication is promptly received. The terminal 718 thenoperates to execute a sequence later described to close the transaction.

If in the step 788 the patient indicates that they accept the charges,then the computer 324 operates in a manner previously described todetermine the storage location in the dispenser 718 of the item typethat has been prescribed for the patient. This is indicated in a step794. If the computer determines that the particular type medical itemfor some reason is not present in the dispenser, the mediation cannot beprovided. If such a determination is made as represented by a step 796then the patient is notified through the output device on the dispenserat a step 798 that the medication is not available. Thereafter thecomputer 324 operates to execute the steps associated with providing thepatient with contact information and notifying the patient's physicianas previously discussed, before closing the transaction. Of course thecomputer 324 may also operate to generate restocking messages so that ifthe medication is not present due to being out of stock then appropriateaction may be taken to reload the particular type medical item in thedispenser.

If the medical item that has been prescribed for the patient at the selfservice dispenser is present in the dispenser, the computer is thenoperative to recover from the database the prescription data which is tobe printed by the system on a prescription label which is provided withthe medical item. In addition or in the alternative, the computer 324may also operate to look up certain instructions or informationconcerning the prescribed medical item so that it may be provided to thepatient. This may include for example instructions on how to take or usethe medical item. It may also include for example food or othersituations to be avoided when taking the medical item. Such informationmay be stored in one of the datastores in the system such as inconnection with the pharmacy system 334. The lookup of this informationis represented by a step 800 in FIG. 66.

In response to determining the label information and/or particularinstructions that are to be provided to the patient with the medicalitem, the computer 324 is operative to send at least one message to theself service dispenser 718. In response to the message the printer 730is operative to print the instructions on paper or other appropriatemedia for the patient. In addition the label printer 732 is operative toprint a medication label such as a self adhesive label that may beapplied to the container which holds the pills or other medical itemwhich is being dispensed for the patient. These printing activities arerepresented by a step 802.

In this exemplary embodiment of the invention the dispenser dispensescylindrical containers which are the medical items dispensed to thepatients. These containers may hold a variety of pills, capsules orother types of medical items. In the exemplary embodiment the labelprinter 732 provides a label to the patient operating the terminal whichthe patient may apply to the medical item immediately after it isdispensed. Of course in other embodiments the self service dispenserterminal may include mechanisms therein for applying the prescriptiondata to the medical item. This may include for example printing a labelwithin the dispenser and then applying the label to the medical itemsusing the mechanism within the dispenser prior to the medical item beingdelivered to the patient. Alternatively medical items may include alabel thereon when loaded in the dispenser. In the process of dispensingthe medical item, indicia corresponding to the prescription data may beprinted on the lable such as through applying printing with an inkjetprinter as the medical item is passed adjacent to the printing device.Various alternatives for applying labels or printing to the medical itemmay be used in embodiments of the invention. These various alternativesmay include applying the prescription indicia either before or after thedispensing of the medical item.

Returning to the logic flow discussed in connection with this exemplaryembodiment, the computer 324 or other connected computer utilizes theaccount information read from the patient's credit or debit card orother information which may be contained in memory to generate at leastone financial transaction message. This financial transaction messagecomprises one or more messages which are sent electronically through thenetwork 738 to an appropriate credit card or debit card processingsystem. These messages are operative to cause the account associatedwith the card presented at the self service dispenser to be charged forthe amount of the co-payment that is due from the patient. Thegeneration of these one or more financial transaction messages arerepresented by a step 804. The charging of the account associated withthe card is operative to provide the entity which operates the selfservice dispenser with the patient's share of the payment that is due onaccount of the dispensing of the medical item.

As represented in FIG. 57 the computer 324 or other computer operated inconnection with the system is also operative to generate messages to thebenefits provider associated with the patient. These messages areoperative to charge the benefit provider with the benefit amount whichthe benefit provider is obligated to pay under the patient's benefitplan. This is represented by step 806 in FIG. 67. In response toreceiving the message requesting the payment, the computer such ascomputer 712 operated by the patient's benefit provider is operative asindicated in step 808 to indicate through a return message to thecomputer 324 whether the benefit provider accepts the obligation to paythe benefit on behalf of the patient.

In the exemplary embodiment if the benefit provider refuses to accept atransaction the computer 324 is operative to note the discrepancy in astep 810. The computer also sends messages to the terminal 718 whichoutputs information through the output device 728 and/or the printer 730concerning the contact information for the entity the patient shouldcontact to resolve the discrepancy. This is represented by a step 812.The exemplary embodiment causes the computer 324 to operate to send amessage to the physician through the physician terminal 702 or otherwiseto notify the physician that the patient did not receive theirmedication. This is represented by a step 814. The output device on thedispenser 718 is operated to display the apology screen to the patientat a step 816 before closing the transaction. In embodiments of theinvention where the patient's account has already been charged for theco-payment amount, the refusal of the payment of the benefit by thebenefit provider may cause the computer 324 to operate in accordancewith its programming to reverse the charge to the patient's account forthe co-payment. This is done through the exchange of electronic messageswith the debit or credit card processing system. Alternatively thetransaction messages exchanged with both the benefit provider and thecredit and debit card processor may require an initial commitment thatthe funds will be made available prior to sending a subsequent messagewhich is operative to transfer the funds. Alternatively the whole amountmay be charged to the patient's account and appropriate credits appliedlater for the amount of any benefits. It should be understood thatvarious approaches to the plural transaction messages are within thescope of the invention depending on the capabilities of the systemoperated by the benefit provider and the credit and debit cardprocessing system from which the patient pays the co-payment amount.

If in a step 808 the benefit provider accepts responsibility for paymentof the calculated benefit amount, or if the patient is paying for thewhole amount, computer 324 is operative to cause the self servicedispenser to deliver to the patient the self adhesive label that hasbeen printed by lable printer 732. If the label is applied through amechanism within the dispenser, the mechanism which applies the labeloperates to attach it to the medical item to be dispensed. Likewiseinstructions that are to be provided to the patient with the dispensedmedication item are delivered to the patient from the printer 730. Thisis represented schematically in a step 818.

In response to the dispense being authorized the self service dispenserterminal then operates in a step 820 to dispense the medication to thepatient. In response to sensing the dispense of the medication, amessage is sent to computer 324. such message is sent in response tosensors within the dispenser of the type previously discussed, sensingthat the medical item has been dispensed. The computer operates toinclude data in the datastore 326 representative of the fact that thetype medical item has been dispensed for this patient. This may includeinformation concerning the dispense including the time and locationthereof, as well as other information that is pertinent such as theaccount of the patient used to make the co-payment and the benefitprovider and benefit amount. The computer 324 also operates to indicatethat the prescription for the patient is no longer open and waiting tobe filled. This is represented by a step 822.

The printer 730 is also operative to print a receipt for the patientconcerning the transaction. This may be in the nature of a transactionreceipt for the debit or credit card payment that the patient has madefor the co-payment amount. Alternatively the print receipt data which isprovided to the patient may be integrated onto the same form withinstruction information that is printed concerning the dispensed medicalitem. This is represented by a step 824.

In the exemplary embodiment described in connection with FIG. 63 thepatient is required to apply the prescription label to the medicationafter the medical item has been dispensed. In this exemplary embodimenta sensor is provided for sensing the presentation of the lable to thepatient. The sensor is in connection with a computer in the self servicedispenser or elsewhere in the system, and in the exemplary embodimentprevents further operation of the terminal until the patient takes thelabel for purposes of applying it to the dispensed medical item. Such afeature may be particularly valuable in systems where the dispenser isconfigured to dispense a series of prescribed medical items for thepatient. For example, in such embodiments the customer may be promptedafter a first item has been dispensed to indicate that they are ready toaccept the dispense of another medical item which may have beenprescribed for the patient. Appropriate outputs to the output device ofthe terminal may be provided for this purpose. If the customer providesappropriate inputs to indicate that they wish to have the additionalmedical item dispensed, such further activity is prevented until afterthe label has been sensed as taken from the presentation position andthe patient has applied that label to the dispensed medical item.Appropriate prompts may be provided through the output device of theself service dispenser to assure and remind patients to take this step.In this way the risk of a patient confusing multiple medical items byinstalling labels incorrectly is reduced. Of course in alternativeembodiments where labels are applied automatically within the dispensingunit, such features may not be required.

If after step 824 no further medical items have been prescribed for thepatient or if the system is programmed to end the transaction after thedispense of a single medical item, the computer operates to control theself service dispenser 718 to return the customer's card at a step 826.After returning the card the dispenser operates to display through itsoutput device a courtesy screen such a screen thanking a customer forconducting the transaction and/or reminding them to contact theirphysician if they have any questions or concerns about theirprescription. This is represented by a step 827. Thereafter the computermay operate the self service dispenser to return to a wait state waitingfor the same or another patient to operate the terminal.

It should be understood that the logic flow shown herein is exemplaryand in other embodiments of the invention other logic flows, selfservice dispensing devices and system configurations may be used.

An advantage of the present invention is that systems of the type whichare used to track and dispense medications to patients on an in-patientbasis may be extended to patients who are receiving treatment on anoutpatient basis. This may be particularly valuable in situations wherea medical care facility has many physicians with offices in the samefacility or a nearby facility who appreciate the convenience of beingable to see patient on both an inpatient and an outpatient basis. Thepresent invention enables such physicians to provide prescriptioninformation for patients in both categories through their offices. Inaddition patients which are seen on an outpatient basis may receivetheir medications quickly and very close in time to their visit with thephysician. As patients requiring medications are not often feeling well,the inconvenience and ordeal of traveling to a drugstore or other remotelocation to obtain their medications may be avoided. In additionexemplary embodiments of the system provide the advantages associatedwith tracking the dispense of medical items previously discussed.

Thus the new system for dispensing and monitoring medical items of thepresent invention achieves the above stated objectives, eliminatesdifficulties encountered in the use of prior systems, solves problemsand attains the desirable results described herein.

In the foregoing description certain terms have been used for brevity,clarity and understanding. However, no unnecessary limitations are to beimplied therefrom because such terms are for descriptive purposes andare intended to be broadly construed. Moreover, the descriptions andillustrations given are by way of examples and the invention is notlimited to the exact details shown or described. In addition, anyfeature of the invention that is described in the following claims as ameans for performing a function shall be construed as encompassing anymeans known to those having skill in the art to be capable of performingthe recited function and shall not be limited to the means disclosed inthe foregoing description or any mere equivalent thereof.

Having described the features, discoveries and principles of theinvention, the manner in which it is constructed and utilized, and theadvantages and useful results obtained, the new and useful structures,devices, elements, arrangements, parts, combinations, systems,equipment, operations, methods and relationships are set forth in theappended claims.

1. A method comprising: (a) storing in a data store in operativeconnection with a computer, data representative of a plurality ofpatients for whom medical items may be used; (b) storing in the datastore, data representative of a plurality of medical items prescribedfor use by corresponding patients; (c) storing in the data store, datarepresentative of a plurality of authorized users; (d) inputting to thecomputer, user data; (e) comparing the input user data to the datastored concerning authorized users and determining that the input userdata corresponds to one authorized user; (f) inputting to the computer,data corresponding to one of the plurality of patients; (g) inputting tothe computer, data corresponding to at least one medical item prescribedfor the one patient; (h) responsive to the determination that the inputuser data corresponds to one authorized user, dispensing the at leastone medical item from a medical item dispenser responsive to readingmachine readable indicia on a report in step (g); and (i) storing in thedata store data representative that the at least one medical item hasbeen taken by the one authorized user.